Five-Step Self-Assessment Evaluation for Microvascular Patency in Non-Living Specimen.

OBJECTIVE: To develop a 5-step evaluation method to predict vessel patency in non-living specimens by analyzing the relationship between this evaluation score and patency rate in rat femoral vessel anastomosis. METHODS: Surgical specimens of rat femoral anastomoses were collected from a basic microsurgery course. Each specimen was recorded during practice conducted on living specimens into Group 1: Successful or Group 2: Failed anastomosis. Then, all specimens were cut and blindly sent for assessment of the quality of anastomosis using the 5-step evaluation method including: (1) General appearance, (2) Passing catheter, (3) Vessel expansion, (4) Fluid outflow and (5) Anastomosis leakage. Total score (10 points) was recorded and compared between the 2 groups. The average score in each group and passing score for successful anastomoses were calculated and reported. RESULTS: A total of 47 femoral vessel anastomoses were studied. There were 25 successful anastomoses in group 1 and 22 failed anastomosis in group 2. The mean scores in group 1 and group 2 were 7.92, and 1.55, respectively. The passing score to determine successful anastomosis was 5 and chosen based on ROC curve. Predicted success rate of the anastomosis at the score of 5-6, 7-8 and 9-10 were 92%-95%, 94%-95% and 100%, respectively. CONCLUSION: The 5-step self-assessment evaluation could serve as an effective tool for new trainees to monitor their practice results during basic microsurgical training in non-living specimen.

Preoperative angulation as a predictor for operations of Wassel type IV polydactyly.

The aim of this study was to find the degree of preoperative metacarpophalangeal (MCP) joint angulation that determines the need for corrective osteotomy and to compare the result for Wassel type IV thumb polydactyly operated by soft tissue reconstruction alone or with corrective osteotomy. The surgical options for correction of the angular deformity of the MCP joint in Wassel type IV thumb polydactyly were retrospectively reviewed. The preoperative angular deformity of the MCP joint and the last postoperative residual deformity at MCP joint were measured from the radiograph of thumb posteroanterior view. The cut-off point of the preoperative MCP angulation that provided less residual deformity in patients who were treated by soft tissue procedures alone was identified from receiver operating characteristic curve. A total of 45 patients with 46 thumb polydactyly (Wassel type IV) were studied. Mean pre and postoperative MCP angulation were 24.01 (range 0-68°) and 14.65 (range 0-39°), respectively. Thirty-four thumbs from 33 patients (73.91%) were operated on by soft tissue procedures alone and 12 thumbs (26.09%) needed corrective osteotomy. The best cut-off point of preoperative MCP angulation that showed less significant residual deformity when treated by soft tissue procedure alone was 30° (96.43% sensitivity and 100% specificity). In MCP angulation ≤30°, soft tissue reconstruction alone was an effective method for correction of angular deformity with predictable outcome of no significant residual deformity (0/27 thumbs). In MCP angulation >30°, corrective osteotomy is recommended over soft tissue procedure alone due to achieve proper thumb position and adequate soft tissue balance. There is also a statistical decrease in significant residual deformity [from 85.71% (6/7 cases, treated by soft tissue procedure alone) to 30% (3/10 cases, treated by corrective osteotomy), P < 0.05]. This study proposes the use of preoperative MCP joint angular deformity as a guide to the type of surgical intervention in Wassel type IV thumb polydactyly.