The anteromedial thigh flap as a training model of a perforator flap in rat.

BACKGROUND: Perforator flap surgery is a complex surgery that is based on the use of a highly precise microsurgical technique that differs slightly from a conventional free flap, especially the intramuscular dissection of the pedicle. Herein, we report a new model of a perforator flap in rat, the anteromedial thigh flap, as a teaching model of a perforator flap. It is based on a constant musculocutaneous perforator that arises from the muscular vessels for the gracilis muscle. MATERIAL AND METHODS: Twenty Wistar rats were used in this study. In 10 rats, an anatomical study was performed by means of anatomical dissection, Chinese ink injection, and microangiography studies, and in 10 rats, a flap transplantation study was carried out by means of transferring a pedicled perforator flap to the abdomen and monitoring its viability by direct inspection on the seventh day. RESULTS: Anatomical studies revealed a constant perforator that has an average length of pedicle up to 20 mm, an external diameter from 0.2 to 0.3 mm, and supplies blood to an area of approximately 3 x 3 cm of the anteromedial region of the thigh. In the flap studies, all the flaps survived on the seventh day after operation. CONCLUSIONS: The anteromedial thigh perforator flap is a reliable, reproducible inexpensive, replicates the handling of a perforator flap very closely, and has an easy method to record the outcomes by visual inspection, so we think that it is a useful tool as a teaching model for training a perforator flap in the preclinical setting.

Design and creation of an experimental program of advanced training in reconstructive microsurgery.

In this study, we design an experimental protocol for the purpose of enhancing performance in training in microsurgery. It is based on five free tissue transfer exercises in rat (epigastric cutaneous flap, saphenous fasciocutaneous flap, epigastric neurovascular flap, saphenous muscular flap, and hindlimb replantation), which simulate the principal clinical procedures of reconstructive microsurgery. The first part of the study consists of an anatomical review of the flaps of 5 rats and in the second part we have carried out the free transfer of flaps on 25 rats divided into 5 groups. To differentiate between them, we have created a mathematical function, referred to as difficulty in a microsurgical exercise, which has enabled us to establish a scale of progression for training, ranging form the easiest to the most difficult. As a conclusion, we believe that this protocol is a useful instrument as it allows for a more precise assessment of microsurgical capacity due to enhanced accuracy in the reproduction of global procedures and the fact that the quantification of progress in training is based on clinical monitoring after 7 days.