Department of Orthopaedics, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Chulalongkorn University, Bangkok, Thailand.
Department of Biochemistry and Orthopaedics, Vinai Parkpian Orthopaedic Research Center, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
J Reconstr Microsurg. 2019 Jun;35(5):315-321. doi: 10.1055/s-0038-1675203. Epub 2018 Oct 26.
Microsuture is an essential material for basic microsurgical training. However, it is consumable, expensive, and sometimes unavailable in the microsurgical laboratory. To solve this problem, we developed a microsuture made from human hair and needle gauge.
Do-It-Yourself (DIY) microsuture is made from human hair and needle gauge 32G (BD Ultra-Fine Pen Needles 4 mm × 32G). Methods are explained step by step. This DIY microsuture (labeled as "test microsuture") and nylon 8-0 (Ethilon suture 8-0, labeled as "standard microsuture") were used for teaching orthopaedic residents to perform arterial anastomosis in chicken thighs. All residents practiced without knowing that "test microsuture" was made from the DIY method. After completing the training, quality of both microsutures was evaluated by questionnaire in topics of (1) thread quality (size, strength, elasticity, handing, knot perform, and knot security), (2) needle quality (size, curve, shape, sharpness, handling, and strength), (3) needle-thread interface (size, strength, and smoothness), and (4) overall quality of microsuture. Each category was evaluated by Likert score (5 = excellent, 4 = good, 3 = fair, 2 = poor, and 1 = very poor).
The DIY microsuture was performed in three steps: (1) insert human hair into needle gauge by microforceps, (2) bend needle into smooth curve, and (3) disconnect needle and create needle-hair interface. The questionnaire was completed by 30 orthopaedic residents and showed that thread quality of DIY and standard microsuture had "good" and "good-to-excellent" quality (mean Likert score: 3.77-4.23 and 3.80-4.27, respectively, with no statistical difference). Thread-needle interface quality of DIY and standard microsuture also had "good" and "good-to-excellent" quality (Likert score: 3.73-4.20 and 4.07-4.33, respectively, with no statistical difference). Needle part of DIY microsuture had lower quality than standard suture (fair-to-good compared with good-to-excellence quality, score 3.30-3.67 vs. 4.20-4.27, respectively, with a statistically significant difference, -value < 0.05). However, overall quality of DIY suture and standard microsuture had "good" and "good-to-excellent" (mean Likert score: 3.73 and 4.00, respectively, with no statistical difference).
The DIY microsuture from human hair and needle gauge could be an alternative for basic microsurgical training with lower cost, easy production, and more availability for use in practice with acceptable quality compared with that of standard microsuture.
显微缝线是基础显微外科训练的必备材料。然而，它是消耗品，价格昂贵，有时在显微外科实验室也无法获得。为了解决这个问题，我们开发了一种用人发和针规制成的显微缝线。
自制（DIY）显微缝线由人发和 32G 针规（BD Ultra-Fine Pen Needles 4mm×32G）制成。方法分步骤说明。这种 DIY 显微缝线（标记为“测试显微缝线”）和尼龙 8-0（Ethilon 缝线 8-0，标记为“标准显微缝线”）用于教授骨科住院医师在鸡大腿上进行动脉吻合术。所有住院医师在不知道“测试显微缝线”是用自制方法制成的情况下进行训练。培训完成后，通过问卷调查评估两种显微缝线的质量，内容包括（1）缝线质量（大小、强度、弹性、手感、结的性能和结的安全性），（2）针质量（大小、曲线、形状、锋利度、手感和强度），（3）针-线界面（大小、强度和光滑度），和（4）显微缝线的整体质量。每个类别均采用李克特评分（5=优秀，4=良好，3=中等，2=差，1=很差）进行评估。
DIY 显微缝线分三步进行：（1）用微夹将人发插入针规，（2）将针弯曲成平滑的曲线，（3）断开针并形成针-发界面。30 名骨科住院医师完成了问卷调查，结果显示，DIY 和标准显微缝线的缝线质量均为“良好”和“良好至优秀”（平均李克特评分分别为 3.77-4.23 和 3.80-4.27，无统计学差异）。DIY 和标准显微缝线的线-针界面质量也为“良好”和“良好至优秀”（李克特评分分别为 3.73-4.20 和 4.07-4.33，无统计学差异）。与标准缝线相比，DIY 显微缝线的针部分质量较低（从“中等”到“良好”，评分 3.30-3.67 与 4.20-4.27，具有统计学意义，-值<0.05）。然而，DIY 缝线和标准显微缝线的整体质量均为“良好”和“良好至优秀”（平均李克特评分分别为 3.73 和 4.00，无统计学差异）。
用人发和针规制成的 DIY 显微缝线可以替代基础显微外科训练，成本更低，易于制作，在实践中更易获得，并且与标准显微缝线相比，其质量具有可接受性。
