Mountbatten Department of Plastic Surgery, Queen Alexandra Hospital, Portsmouth, UK,
Canniesburn Plastic Surgery and Burns Unit, Glasgow Royal Infirmary, Glasgow, UK.
Eur Surg Res. 2023;64(2):301-303. doi: 10.1159/000521439. Epub 2021 Dec 15.
We have recently incorporated simple modifications of the konjac flour noodle model to enable DIY home microsurgical training by (i) placing a smartphone on a mug to act as a microscope with at least ×3.5-5 magnification, and (ii) rather than cannulating with a 22G needle as described by others, we have found that cannulation with a 23G needle followed by a second pass with an 18G needle will create a lumen (approximately 0.83 mm) without an overly thick and unrealistic "vessel" wall. The current setup, however, did not allow realistic evaluation of anastomotic patency as the noodles became macerated after application of standard microvascular clamps, which also did not facilitate practice of back-wall anastomoses. In order to simulate the actual operative environment as much as possible, we introduced the use of 3D-printed microvascular clamps. These were modified from its previous iteration (suitable for use in silastic and chicken thigh vessels), and video recordings were submitted for internal validation by senior surgeons. A "wet" operative field where the konjac noodle lumen can be distended or collapsed, unlike other nonliving models, was noted by senior surgeons. With the 3D clamps, the noodle could now be flipped over for back-wall anastomosis and allowed patency testing upon completion as it did not become macerated, unlike that from clinical microvascular clamps. The perceived advantages of this model are numerous. Not only does it comply with the 3Rs of simulation-based training, but it can also reduce the associated costs of training by up to a hundred-fold or more when compared to a traditional rat course and potentially be extended to low-middle income countries without routine access to microsurgical training for capacity development. That it can be utilized remotely also bodes well with the current limitations on face-to-face training due to COVID restrictions and lockdowns.
我们最近对魔芋粉丝面条模型进行了简单的修改，以便通过以下方式实现 DIY 家庭微创手术培训：(i) 将智能手机放在杯子上充当显微镜，放大倍数至少为×3.5-5；(ii) 我们发现，与其他人描述的用 22G 针进行套管穿刺不同，用 23G 针进行套管穿刺后，再用 18G 针进行第二次穿刺，可形成一个管腔（约 0.83mm），而不会形成过于厚且不真实的“血管”壁。然而，当前的设置不允许对吻合口通畅性进行现实评估，因为面条在应用标准微血管夹后会被浸渍，这也不利于后壁吻合的练习。为了尽可能模拟实际手术环境，我们引入了 3D 打印微血管夹的使用。这些夹具是对其前一迭代的修改（适用于硅橡胶和鸡腿血管），并提交视频记录供资深外科医生进行内部验证。资深外科医生注意到，这是一个“湿”手术环境，魔芋面条管腔可以扩张或塌陷，与其他非活体模型不同。使用 3D 夹具，面条现在可以翻面进行后壁吻合，并在完成后进行通畅性测试，因为它不会像临床微血管夹那样被浸渍。这种模型有许多优点。它不仅符合基于模拟的培训的 3R 原则，而且与传统的大鼠课程相比，还可以将培训成本降低 100 倍甚至更多，并且当没有常规的显微外科培训能力时，还可以扩展到中低收入国家。它可以远程使用，这也很好地适应了由于 COVID 限制和封锁而导致的面对面培训的当前限制。
