Mehmet Oguz Yenidunya,

Taku Tsukagoshi, and Yoshiaki Hosaka

TECHNICAL IDEAS AND INNOVATIONS

MICROSURGICAL TRAINING
WITH BEADS

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ABSTRACT
To assist beginners in the microsurgical practices of handling instruments and tying knots before us-
ing an animal model, the authors suggest the use of colored beads. These beads will diminish eyestrain
and secondary fatigue. Also, working with colored beads might be a little more amusing and enjoyable for
beginners in learning microsurgical techniques during preliminary studies to achieve the necessary ori-
entation for working under the operating microscope.

Surgical practice should include handling in- be very gentle in grasping with the forceps as, with
struments, tying knots, making incisions, suturing too much pressure exerted, the tough bead will jump
wounds, and finally completing the operative proce- outside the field between the two legs of the forceps.
dure.1 In no field of medicine is it advisable to di- These maneuvers teach the crucial and gentle han-
rectly begin practice with patients. Although live ani- dling of tissue that is paramount in microvascular
mals represent an ideal training medium, the human surgery.
placenta, other tissues, and non-animal models have
also been suggested.2"5 Or one can pray for well-
avulsed skin in any emergency department! 6
In the laboratory, it is not only arms and hands
that become weary during microscope studies, but
also eyes. Several years ago, Sheehan 7 pointed out
that the use of color during operative procedures
permits a more normal pupillary opening, thereby di-
minishing eyestrain and secondary fatigue. The de-
scription presented permits the beginner to practice
handling instruments and tying knots under magnifi-
cation with the surgical microscope. All that is
needed, in addition to standard microsurgical instru-
ments, is a pack of round, flat, colored beads, with an
external diameter of 1 to 2 mm; the purpose is to pro-
duce micro-necklaces.
First, thread is cut to approximately 5 cm in
length. Then, with a hemostat, the thread is held at
Figure 1. Use of colored beads during the sug-
one end to keep it stable. Beads are passed on the gested procedure, or the use of color during operative
other end of the thread with jeweler's forceps, by procedures, will diminish eyestrain and secondary fa-
grasping the bead only externally. It is important to tigue (1, metric measure; 2, colored beads). 197

Showa University School of Medicine, D e p a r t m e n t of Plastic and Reconstructive Surgery, Tokyo, lapan Reprint requests-. Dr. Yenidunya,
Showa University School of Medicine, Dept. of Plastic and Reconstructive Surgery, H a t a n o d a i 1-5-8, Shinagawa-ku, Tokyo 142, lapan Ac-
cepted for publication July 30, 1997 Copyright © 1998 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001. All
rights reserved.
 JOURNAL OF RECONSTRUCTIVE MICROSURGERY/VOLUME 14, NUMBER 3 APRIL 1998

Figure 2. The goal is to produce micro-necklaces

(4) (3, thread segments).

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Figure 3. Some ideograms or other patterns can
also be produced with the colored beads. The ideogram
demonstrated means "plastic surgery" in Japanese.
For each thread segment, about seven to eight
beads can be threaded, and it is easy enough to
string the beads under X 10 or X 16 magnification, and
McGregor jC, Wyllie FJ, Grigor KM. Some anatomical observa-
to make a knot under X6 magnification (Figs. 1-3). tions on the human placenta as applied to microvascular
surgical practice. Br | Plast Surg, 1983;36:387
Kim DC, Niazi ZBM, Hayward PG, Morrison WA. Training model
for microvessel anastomosis. Microsurgery, 1994; 15:820
REFERENCES Guler MM, Rao GS. Canniesburn "ever-ready" model to prac-
tise microsurgery. Br ] Plast Surg 1990;43:381
1. Waynforth HB. Basics of surgery. In Tuffey AA (ed) Laboratory Govila A, Sharma D. Microsurgical practice on avulsed skin. Br
Animals, 2nd ed. Chichester: |ohn Wiley and Sons Ltd., 1996 ) Plast Surg 1990;43:250
2. Goldstein M. Use of fresh human placenta for microsurgical Sheehan ]E. Scientific use of colour to prevent surgical as-
training. ] Microsurg 1979; 1:70 thenopia. Plast Reconstr Surg 1950,5:496

198