A simple cost-effective method of microsurgical simulation training: the turkey wing model.

The rat femoral artery (RFA) anastomosis model has been the gold standard in microsurgical simulation training. While effective, live animal use requires animal use committee regulation and costly maintenance. Our institution's animal laboratory is remote to the hospital, limiting access by our busy surgical residents with their limited duty hours. We present an alternative convenient, cost-effective model. Ten frozen turkey wings were divided into distal and proximal segments. Vessel diameter, length, and anastomosis perfusion were assessed. Proximal brachial arteries ("humeral" segments) measured 8.85 ± 1.14 cm long with diameter 1.69 ± 0.27 mm. Distal brachial arteries ("forearm") measured 10.5 ± 2.06 cm long with diameter 1.25 ± 0.25 mm. An 8-lb box (~20 wings) cost $13.76. Separate use of the segments provides two training sessions with $0.35 per session effective cost. Our average cost for RFA microsurgical training sessions was $120 dollars for a single rat 2-hour session and $66 per rat if a maximum crate load of six rats was used. Besides significant cost, not all training programs are equipped to house, care for, and use rats in microsurgical training. We now use turkey wings for microvascular training. They are cheap, abundant, readily accessible for training, and consistent with tissue quality and vessel size approximating human systems.

Total patellar skin loss from cryotherapy after total knee arthroplasty.

The use of cryotherapy after total knee arthroplasty is a very common therapeutic adjunct accepted as routine postoperative care. We present 2 cases of total patellar skin loss due to cryotherapy after total knee arthroplasty. Substantial soft tissue defects were created after the initial debridement of the necrotic tissue. Both patients were evaluated for frostbite, and the wounds were sharply debrided. Application of an advanced wound management technique involves the use of a collagen-glycosaminoglycan biodegradable bilayer matrix, silver impregnated antimicrobial dressing, and low-pressure vacuum device, followed by delayed split thickness skin grafting and low-pressure vacuum device. We find that this technique provided durable soft tissue coverage for necrotic wounds of the knee that do not involve the joint capsule.