Carine Laroche & Christian Vacher

Summary

Microsurgical vascular anastomosis in reconstructive surgery learning is usually based on rat dissection. But this technique does not allow dissection of the flap, preparing of the recipient vessels training, and suturing in conditions as realistic as possible of the surgery. The aim of this study was to describe a technique of surgical anatomy learning on human fresh cadavers, easy to perform and to evaluate its pedagogic interest. In the first part of the study, six fresh cadavers have been dissected simulating 6 forearm flaps with growing difficulty. In the second part of the study, 30 residents in surgery were evaluated on their ability to recognize main anatomic structures and to perform microsurgical anastomosis, of forearm flaps anastomosed on facial vessels. Concerning the first part of the study, it has been possible to use this method in all cases. The second part of the study showed that all the residents performed the dissection of the flap with success. The main anatomic structures (origin of the radial and ulnar arteries, companion veins of radial artery) have been identified by all the residents. The cephalic vein, the median antebrachial vein and the superficial branch of the radial nerve have been identified by most of the residents. The lateral antebrachial cutaneous nerve has been identified by only 12 residents. The arterial anastomosis has been performed with success in most cases (11/15 dissections), and the venous anastomosis in only 5/15 dissections. Surgical anatomy learning in the field of microvascular reconstructive surgery on human fresh cadavers is possible, easy to organize in a anatomy department. This method has to be considered as a useful complement of microvascular anastomosis learning on rats.

KEY WORDS: Anatomy; Cadavers; Microsurgery; Reconstructive surgery; Teaching.

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