فهرست مطالب

Plastic Surgery - Volume:8 Issue: 2, 2019
  • Volume:8 Issue: 2, 2019
  • تاریخ انتشار: 1398/01/28
  • تعداد عناوین: 20
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  • Sina Kardeh*, Nasrin Saki, Farideh Jowkar, Bahareh Kardeh, Seyed Arman Moein, Mohammad Hossein Khorraminejad, Shirazi Pages 127-134
    BACKGROUND
    Antibiotics are commonly used in the treatment of acne vulgaris. Considering the rise of antibiotic resistance, alternative medications may be used in the main anti-acne armamentarium. The aim of this study was to investigate the efficacy of oral azithromycin in the treatment of acne vulgaris.
    METHODS
    Database searches were performed in PubMed and Scopus using the keywords "azithromycin" and "acne".
    RESULTS
    Azithromycin 500 mg once daily for 3 days per week or in cycles of 10 days for 12 weeks are the most commonly used regimens.
    CONCLUSION
    Available experimental data suggest that oral azithromycin is an effective and well-tolerated option for treatment of acne vulgaris.
    Keywords: Azithromycin, Tetracycline, Doxycycline, Acne vulgaris, Treatment
  • Fatemeh Salehahmadi*, F Hajialiasgari Pages 135-145
    Computer as an integral part of continual advancements in medicine has experienced tremendous development to minimize the risks and improving the precision of the surgery. Our review included multi-disciplinary publications in English from 2014 to 2017 using Springer, Oxford library, Elsevier, PubMed, Google Scholar, and Springer search engines using terms of “augmented reality (AR), “plastic surgery,” and “surgery “ and “Augmented Reality Ethics and challenges”. It was shown that AR has been successfully effective in different branches of surgery, but with concerns and challenges like acceptance, privacy, different physical, security and behavioral threats. To come over them partially, a methodological approach for cyber threat landscape proactive exploration has been suggested.
    Keywords: Augmented reality, Surgery, Rewards, Drawbacks
  • Werner Dennis, Seyed Arash Alawi* Pages 146-162
    BACKGROUND
    Disseminated intravascular coagulopathy (DIC) is a rare symptom complex that causes embolisms within the microvasculature and extensive necrosis of the skin and the acres. During surgical decision-making, preserving functionally important structures must be weighed against radical debridement. The aim was to analyze functional recovery and quality of life of patients sustaining amputations from disseminated intravascular coagulopathy and supplied with bionic prostheses.

    METHODS
    A monocentric, retrospective review of patients with disseminated intravascular coagulopathy after sepsis was conducted from 2016 to 2018. After initial reconstruction and intensive care treatment, patients were provided with bionic prosthetic devices. A follow-up survey measuring function and quality of life was performed.

    RESULTS
    Three patients (mean: 45 years; median: 50 years) were analyzed. The first necrectomy and amputation were performed, on average, after >4 weeks post-symptom onset. All patients required re-amputation, averaging two or one re-amputations in the right or left upper extremity, respectively, and one in ​​the lower extremities. On average, 12 operations for reconstruction of skin defects were required (x͂=8). On average, patients tolerated their prostheses for 5.67 h per day. Satisfaction metrics were either sufficient (SF-36, x̅=69) or moderate (TAPES-R, x̅=4.7). Physical skills were rated poor to fair (average TAPES-R=2.67). 

    CONCLUSION
    Supplying bionic prostheses after DIC yielded sufficient to moderate results. However, prothesis weight, signal transmission disorders, and repeated functional failures were suboptimal. For extensive stump scarring, implantable signal electrodes may improve signal transmission.
    Keywords: Disseminated intravascular coagulopathy, Amputation, Reconstruction, Bionic, Myoelectric, Prosthesis, Rehabilitation
  • Sung, Hwan Kim, Bommie Florence Seo, Young Choi, Yong, Seog Oh*, Ju Youn Kim Pages 163-170
    BACKGROUND
    The prepectoral implantation technique has been the standard procedure for cardiovascular implantable electronic device (CIED). However, it cannot be performed in such patients with thin skin or patients with cosmetic concerns. This study was designed to demonstrate the feasibility and safety of the subpectoral compared to the prepectoral approach.
    METHODS
    We conducted a retrospective, nonrandomized comparison of the prepectoral (234 cases) and subpectoral approach (32 cases) in patients who received CIED implantation at a tertiary center between July 2012 and May 2015. We compared lead characteristics, procedure time and complications between the subpectoral and prepectoral approach.
    RESULTS
    In the subpectoral group, two complications were observed, whereas six complications were found in the prepectoral group (2/32 vs. 6/234, respectively, p=0.25). In the subpectoral group, one patient developed wound infection and the others were safely conducted without any complications. In the prepectoral group, two patients developed hemopericardium, three developed pocket hematoma requiring surgical revision, and one developed a pneumothorax. Procedure time in the subpectoral group took longer than that in the prepectoral group (150±50 min versus 91±49 min, p=0.06). In lead characteristics, there were no significant differences between the two groups.
    CONCLUSION
    The subpectoral approach is technically feasible and non-inferior to the prepectoral approach, in the aspect of complication and lead characteristics, but seemed to take more procedure time. The subpectoral approach is a more reasonable choice for selected patients in whom the prepectoral approach is not feasible or in individuals who have cosmetic concerns.
    Keywords: Cardiovascular, Subpectoral, Prepectoral, Implantation, Cosmetic
  • Verdiana Di Pietro, Marcello Colicchia Gianfranco, Valerio Cervelli, Pietro Gentile* Pages 171-180
    BACKGROUND
    Thigh’s lifting can be associated with significant complications, if the medial thigh excess is removed en bloc. In this study, the liposuction-assisted medial thigh’s lift (LAMeT) procedure, outcomes and complications were assessed.
    METHODS
    Twenty four females between 25 and 61 years with grade 2 or 3 on Pittsburgh Rating Scale (PRS) treated with medial thigh’s reduction were enrolled. Medial thigh’s reduction was performed in three different procedures of vertical, horizontal and LAMeT. Vertical thigh’s lift with fascia suspension was conducted in 13 patients with grade 3 of ptosis on PRS; horizontal thigh’s lift with fascia suspension was undertaken in 3 patients with grade 2 on PRS; vertical and horizontal thigh’s lift considered as control group was described as excision-only group; and LAMeT was performed in 8 patients with grade 2 and 3 on PRS.
    RESULTS
    Complications were observed in 62.5% of patients who underwent vertical or horizontal thigh’s lift with fascia suspension and in 16.7% who experienced the LAMeT without fascia suspension. The most frequent complication was seroma. Hospital stay was significantly lower in the LAMeT.
    CONCLUSION
    Medial thigh’s lift is a safe and satisfying procedure because it provides aesthetic improvement in massive weight loss patients. The complication rate is higher when skin excess and laxity are removed en bloc, as the resection of excess tissue is poorly selective. The LAMeT preserves lymphatic and blood vessels and allows a more anatomical resection of the excess skin. Thus postoperative complications incidence is lower and the patient heals faster.
    Keywords: Medial thigh contouring, Weight loss, Liposuction-Assisted Medial Thigh Lift
  • Ajaz Ahmad Shah*, Ashiq Hussain Raina, Mudasir Ahmad Ganie, Irshad Ahmad Kumar Pages 181-184
    BACKGROUND
    About 60-70% of ganglion cysts are found in dorsal part of the wrist. This study compared aspiration followed by intra-lesional steroid (triamcinolone acetate) injection and surgical excision in the management of dorsal wrist ganglion.
    METHODS                   
    From Aug 2016 to Aug 2018 in Department of General Surgery, Government Medical College Srinagar, India, 86 Patients with dorsal wrist ganglions were enrolled. The patients were divided to two groups undergoing two different treatment modalities including 68 patients of aspiration with intralesional triamcinolone acetonide injected into the cyst (group A) and 18 patients with surgical excision (group B). Follow up time was 1, 3, 6 and 12 months.
     
    RESULTS
    Successful treatment was noticed in 59 patients of group A (86.8%), and in 15 patients of group B (83.3%).
    CONCLUSION
    Aspiration followed by intra-lesional steroid injection was better managed in comparison to surgical excision.
    Keywords: Aspiration, Intra-lesional, Steroid, Surgery, Excision, Dorsal wrist ganglion
  • Subha Dhua, Suhas T.R., Balagangadhar Tilak* Pages 185-194
    BACKGROUND
    Autologous platelet rich plasma (PRP) has significant benefits facilitating improved graft take on wound beds due to hemostasis, adhesive and healing properties. This study aimed at effective use of PRP in wound beds on graft take irrespective of etiology as compared to conventional methods of mechanical fixation using sutures and staples.
    METHODS
    Forty cases including 20 in control and 20 in PRP groups admitted to the Department of Plastic Surgery at Vydehi Institute of Medical Sciences and Research Centre, Bangalore were enrolled between October 2015 and September 2017. Freshly prepared autologous PRP was applied on wound beds in the treated group, while conventional mechanical fixation methods like staples and sutures were used in the control group for the fixation of the skin grafts.
    RESULTS
    Most significant result was the instant graft take to the wound bed irrespective of the etiology besides hemostasis and healing properties in the PRP treated group which resulted in considerable reduction of surgeon’s time required for the removal of sutures and staples at the final stages. Also, only 10% with graft edema were noted in the PRP treated patients as compared to 68% in the control group. The inner dressings and skin graft were dry in the PRP group and the post-operative etching, weeping and pain at the graft site reduced.
    CONCLUSION
    The cosmetic appearance of this scar was better in the PRP group besides post-operative edema and graft loss. The study recommends use of PRP at the recipient site of split thickness skin graft.
    Keywords: Platelet rich plasma, Autologous, Wound, Split thickness skin graft, Graft
  • Nader Elmelegy, Sameh Elghamry*, Tarek Shoukr Pages 195-199
    BACKGROUND
    Functional and cosmetic outcomes affect reconstruction of the face more than any region of the body. To use a predetermined perforator flap freely designed allowing a wide range of movement and manipulation can give us an optimum outcome. We present our clinical experience with free style facial perforator flaps, surgical technique, and complications. 
    METHODS 
    Thirty patients with post-tumor resection of the face were reconstructed with free style local perforator flaps between January 2014 and November 2016. Doppler was used to identify the perforator vessels preoperatively. 
    RESULTS
    Twenty-two clinical cases had no complications. Four had venous congestion that resolved spontaneously, three had a distal 1/3 superficial necrosis, and one suffered from hematoma. 
    CONCLUSION
    Freestyle perforator flaps were applied to get better cosmetic facial reconstruction, allowing one stage procedure and decreasing donor site morbidity. Modern anatomical understanding, good planning, and meticulous surgical technique can affect clinical results.
    Keywords: Perforator, Flap, Aesthetic, Facial, Reconstruction
  • Hossein Masoomi*, Berry Fairchild, Erik S. Marques Pages 200-207
    BACKGROUND
    Surgical site complication (SSC) is one of the known complications following autologous breast reconstruction. The aim of this study was to evaluate the frequency and predictors of 30-day surgical site complications in autologous breast reconstruction.
    METHODS
    American College of Surgeons National Surgery Quality Improvement Project (ACS-NSQIP) database was used to identify patients who underwent autologous breast reconstruction during  2011-2015. Multivariate regression analysis was performed to identify independent perioperative risk factors of SSC.
    RESULTS
    Totally, 7,257 patients who underwent autologous breast reconstruction surgery were identified. The majority of the procedures were free flap (60%) versus pedicled flap (40%). The mean age was 51 years and the majority of patients were classified as American Society of Anesthesiologists (ASA)-II (60%) and 15% of patients had BMI>35. The overall 30-day SSC rate was 6.3%. The overall frequency of different types of SSC were superficial incisional infection (3.2%), wound dehiscence (1.8%), deep incisional infection (1.4%) and organ space infection (0.6%). BMI>35 (adjusted odds ratio [AOR]=2.38), smoking (AOR=2.0), diabetes mellitus (AOR=1.67) and hypertension (AOR=1.38) were significant risk factors of SSC. There was no association with age, ASA classification, steroid use, or reconstruction type.
    CONCLUSION
    The rate of 30-day SSC in autologous breast reconstruction was noticeable. The strongest independent risk factor for SSC in autologous breast reconstruction was BMI>35. The type of autologous breast reconstruction was not a predictive risk factor for SSC. Plastic surgeons should inform patients about their risk for SSC and optimizing these risk factors to minimize the rate of surgical site complications.
    Keywords: Frequency, Predictor, Surgical site, Complication, Autologous, Breast, Reconstruction
  • Rohollah Abbasi, Ali Dowlati, Mohammad Reza Seif Rebiei, Farnaz Hashemian* Pages 208-212
    BACKGROUND
    The deviated nose is a common deformity encountered in rhinoplasty, and yet it is the most challenging pathology to treat, because multiple internal and external structures have deformity, so there is a need to be corrected. 
    METHODES
    The intermediate short osteotomy has been applied as a technique to correct severe nasal bony deviations. Eleven patients with severe deviated nose who had been operated by the senior author from 2013 through 2016 were included in the study (follow-up period of 6-24 month). Intermediate short osteotomy was performed after medial and before lateral osteotomy. Surgical outcomes were assessed by another otolaryngologist based on review of pre- and post-operative (6 to 24 months after surgery) photographs. The post-operative outcome in terms of deviation correction was classified as excellent, good, fair, or no change.
    RESULTS
    Of all 11 cases, 6 (54.5%) were accepted as excellent, 4 (36.4%) as good, and 1 (9%) as no change.
    CONCLUSION
    Intermediate short osteotomy can be considered as a modification of intermediate osteotomy that eliminates nasal dorsal deviation more completely. This osteotomy is very simple and need only 1 to 2 minutes and use of this method is recommended for correction of severe deviated bony noses.
    Keywords: Deviated nose, Crooked nose, Rhinoplasty, Osteotomy
  • Mohammad Ali Hoghoughi, Raha Habibagahi* Pages 213-218
    BACKGROUND
    Various techniques have been used for cleft repair such as the straight-line closure, the rotation advancement technique and the anatomic subunit approach which are famous new approaches gained popularity. However, these methods have several advantages and disadvantages and sometimes are difficult to adopt. In this study, we described our novel technique, known as separated multiple Y-to-V-plasty, in treatment of several cases of unilateral cleft lip.
    METHODS
    Plastic surgeons usually try to avoid straight closure of the wound, especially in areas where they need to stretch, move and enhance the length of the wound in some stages of the procedure. Since the lip is a dynamic and active structure and is constantly moving, the use of straight-line incision and closure in that area is in conflict with this basic concept.
    RESULTS
    In our newly introduced technique, we avoided a straight-line closure along the skin and mucosa for the repair of the unilateral cleft lip. This issue is of utmost importance in cases with severe loss of lip height and discrepancy.
    CONCLUSION
    To acquire a natural and balanced shape in unilateral cleft lip repair, we recommended the novel Y-to-V-plasty technique as an effective method for severe unilateral cleft lip with enormous discrepancy.
    Keywords: Cleft lip, Y-to-V-plasty, Repair, Aesthetic
  • Sadrollah Motamed, Peyman Mohammadi Torbati, Hamid Zaferani Arani, Amir Reza Motabar*, Amirhossein Zabolian, Zahra Madadi Pages 219-228
    BACKGROUND
    Cartilage grafts are generally accepted for the restoration and reconstruction of nasal contours. The main concern that plastic surgeons may need to address after surgery pertains to the resorption and disfigurement of the grafted cartilage, especially in allogenic and heterogenic grafts.
    METHODS
    A total of 12 white rabbits were divided into three groups according to the types of graft including autograft, allograft, and heterograft. We used three shapes of grafts, including block, crushed, and diced cartilage in the upper, middle, and lower rows. However, in each rabbit, these grafts were divided into two columns of wrapped and unwrapped grafts, with human amniotic membrane (HAM) grafted on each side of the rabbit’s back.
    RESULTS
    In total, 60 specimens underwent histopathological examination. No inflammation was observed in about 50% of the block-shaped conchal cartilages with HAM, and in 50%, less than 25 inflammatory cells per unit were seen. The prognosis and absorption of autograft specimens in block-shaped cartilages with HAM were significantly better compared with other shapes of cartilages with HAM and without HAM. The proliferation rate of fibroblasts in autograft and allograft specimens was more than that in heterograft specimens with HAM.
    CONCLUSION
    Our findings have demonstrated the new role of HAM in clinical applications, indicating that HAM may be used as a low-cost, easily accessible alternative for wrapping in cartilage grafts instead of fascia or surgicel in early future. It is useful for improving the long-term outcomes and decreasing the resorption rate.
    Keywords: Graft, Cartilage, Amniotic membrane, Rabbit
  • Mahdi Gholami, Arya Hedjazi, Amir Kiamarz Milani* Pages 229-236
    BACKGROUND
    Reconstruction of the head and neck defects is still one of the most challenging surgeries for the surgeons. This study investigated on anatomic variations of fibula free flap in human fresh cadavers.

    METHODS
    Twenty fibula free flaps harvested from 10 fresh human corpses were enrolled. The number and type of skin perforators and their origin were recorded during the flap harvesting. After the completion of flap harvesting, the length of vascular pedicle and diameter of the artery and vein at the origin, the fibula length, the distance of the head of fibula to the site of peroneal artery bifurcation and harvesting time were also recorded. 

    RESULTS
    The fibula free flaps were performed on 2 women and 8 men with the mean age of 35.6 years. The average number of perforators per flap was 1.7, most of which were musculocutaneous (35.29%) from soleus muscle. The mean fibula length was 33.1 (range: 31-35) cm. The mean distance of the head of fibula to the site of peroneal artery bifurcation from the tibialis posterior trunk was 5.76 (range: 4.5-6.5) cm. The mean length of the pedicle flap was 11.15 (range: 10-13) cm. The mean diameters of the peroneal artery and vein at the origin were 2.83 and 51.5 mm, respectively. 

    CONCLUSION
    Although the fibula osteocutaneous flap is a reliable choice for maxillofacial reconstruction, flap harvesting is fairly difficult. Accordingly, surgeons must be aware of anatomical variations of the flap and have a suitable case selection to minimize the risk of surgical complications
    Keywords: Fibula, Free flap, Fresh cadaver, Skin perforators
  • Shahriar Loghmani, Alireza Loghmani, Fatemeh Maraki* Pages 237-244
    BACKGROUND
    Rib cartilage is an outstanding material in reconstructive septorhinoplasty, especially in revision surgery with a low rate of complications compared to other materials. In this study, the results of oblique splitting of rib grafts were evaluated in 25 patients operated for primary and secondary septorhinoplasty.
    METHODS
    The prospective case series were undertaken on 25 patients of saddle or crooked nose that referred to the senior author’s private office between January 2015 and November 2017. They had primary and secondary septorhinoplasty using autologous costal cartilage carved by the oblique split method (OSM). The postoperative follow-up period ranged from 3 to 36 months (Mean follow up of 19 months).
    RESULTS
    The problems seen in patients were saddle-nose deformity in 16 cases, crooked-nose deformity in 3, crooked nose and saddle nose in 3 and implant infection, inverted V-pinch, destruction of septum in 3 more cases. After oblique split rib grafts surgery and 3-36 month follow-up (an average of 19 months), the operative outcomes were successful and no severe resorption, infection, warping or displacement were observed related to graft and patients were also satisfied, and there was no complication of the donor-site. The patients did not have any post-operative complications and no complain of nasal distortion during follow up period.
    CONCLUSION
    OSM allowed obtaining large quantities of graft material without the risk of warping due to inclusion of both peripheral and central portions of the rib cartilage.
    Keywords: Oblique split method, Rib, Graft, Septorhinoplasty, Cartilage
  • Mojtaba Nasiri, Mohammad Hosein Kardar* Pages 245-248
    BACKGROUND
    Basal cell carcinomas (BCCs) are locally invasive periocular skin cancers affecting lower eyelids more than upper eyelids. The purpose of this study was to describe techniques used for lower eyelid reconstruction after extended excision of BCC. 
    METHODS
    Eight referred patients with BCC who underwent lower eyelid reconstruction were enrolled. The tumor was surgically excised with sufficient margins by one surgeon. Defects were repaired by subdermal tunnel between lateral border of defect and insertion site of lateral cantus. 
    RESULTS
    Eight patients aged 45 to 75 years were followed up for 6 months. After follow up, adequate viability of the grafts, satisfactory functional and good cosmetic results was noticed in all patients. One patient complained of irritation at the site of surgery. No total or partial necrosis, hematoma, or infection were observed in flaps, and no additional surgery was needed. 
    CONCLUSION
    The present novel surgical procedure was useful to close full thickness defects in the lower lid to preserve the function of the lower eyelid and a good aesthetic outcome.
    Keywords: Nasojugal flap, Dermal pennant, Lower lid
  • Mojtaba Nasiri, Mohammad Hossein Kardar* Pages 249-253
    BACKGROUND
    Microvascular surgery is one of the most important parts of reconstructive surgery. In the present study, the effect of ethanol on microvascular diameter and prevention of thrombosis was evaluated.
    METHODS
    Totally, 80 vessels including 40 arteries and 40 veins in right and left ears of 20 adult rabbits were enrolled. Seven days after injection of ethanol to rabbit ear vessel, vessel diameter and thrombosis rate post-iced saline challenge were documented and compared to normal saline injection in contralateral ear as a control group.
    RESULTS
    Vessel diameter in both arteries and veins in ethanol group was significantly larger than normal saline control group, and patency rates due to preventive effect of ethanol were also significantly higher in the ethanol group after iced saline challenge.
    CONCLUSION
    Pretreatment with ethanol can enlarge vessel diameter and play a preventive role on thrombosis after iced saline challenge.
    Keywords: Ethanol, Vessel, Diameter, Thrombosis, Rabbit
  • Masoumeh Ghoddusi Johari, Ali Akbar Mohamadi*, Vahid Dastgerdi Pages 254-258
    BACKGROUND
    Epilepsy, the world’s most common neurological brain dysfunction, affects more than 50 million people worldwide. Burn injuries can be the leading cause of morbidity and mortality in the patients. This study assessed the predictable but preventable tragedy in epileptic burn patients.
    METHODS
    From January 2001 to January 2011, data included patient’s demographic, burn cause, Total Body Surface Area (TBSA) of the burn injury, patient’s risk awareness, the type of treatment required as well as the treatment outcome were collected from burn admissions. Totally, 39 patients who sustained burn injuries due to epileptic seizures w were enrolled.
    RESULTS
    Totally, 39 (1.7%) were epileptic with mean age of 30±11 years, 51.3% were female, 41.2% were single and 53.84% were rural residents and 12.8% had academic education. The majority of the thermal injuries occurred at home (82.1%). Flame was the most common cause of burn (66.7%). The mean Total Body Surface Area was 19.69±18.25. Finally, 38 patients were discharged with mortality rate of 2.6%. Thirty patients underwent split or full thickness graft as the most common surgery. Only 5 patients were aware of the burn injury risk during seizure attack.
    CONCLUSION
    Despite reduction in burn injuries secondary to seizure, still such injuries lead to significant morbidity and mortality. Since these patients should adhere to specific medication, controlling it remains to be difficult. So preparation for preventive strategies is consisted of life style modification along with patients’ education that is further warranted.
    Keywords: Burn, Injury, Patient, Prevent, Epilepsy, Iran
  • Kavish Maheshwari*, Sandip Hindocha, Ali Yousif Pages 259-261
    Pilar cysts are common cysts on the scalp and hair bearing area of the body. We found one such cyst on the dorsum of the thumb. There have been previous reports of them in the finger tips as a very rare occurrence. The site of this lesion supports the theory of a possible origin from the nail matrix. These lesions, even when found at unusual sites should have pilar cyst as a differential diagnosis. They must always be excised and subjected to careful histopathology to rule out proliferating trichilemmal cysts, which carry a rare risk of malignancy.
    Keywords: Pilar cyst, Trichilemmal cyst, Benign hand cyst
  • Ritul Patel*, Prutha Patel, Viral Kalariya, Het Patel, Chetan Chavada Pages 262-264
    Improper and inadequate treatment can lead to oro-antral communication and fistula. Certain surgical procedure during operation in posterior maxilla can lead to communication between oral cavity and sinus. In children and adolescents, the risk of oro-antral communication is less, due to smaller volume of the maxillary sinus defect smaller than 2 mm that would adequately heal without any intervention, but larger communications more than 2 mm would require immediate attention from surgeon and treatment should be done as soon possible in order to avoid further complications, infection and patient’s discomfort.
    Keywords: Oro-antral, Closure, Flap, Fistula
  • Bilsev Ince, Mehmet Emin Cem Yildirim*, Mehmet Dadaci Pages 265-266
    Although the number of microsurgical operations increase day by day, it is still difficult to learn due to the requirement of specific subset of skills. Unlike traditional surgery, experience with microsurgical instruments and performing with microscope is very important for success.1 Generally, microsurgical training programs involve silastic tubes and practice on experimental
    animals or cadavers.2,3 The use of experimental animals and cadavers in microsurgical training is believed to be a gold standard. However, the use of a simulation model to gain experience with
    microscope and microsurgical instruments may be more ethically acceptable.
    We would like to present a simulation model that we use in basic microsurgical training program of our clinic, which is very cheap and can be reached easily in every hospital. The model can
    be created using fingers of a surgical glove, a glue, an injector needle and two injector needle caps. The needle cap is cut in half and the distal parts of the caps are brought together. Then injector needle is passed from one to another (Figure 1a). Fingers of the glove are wrapped and glued on both sides of the caps.
    (Figure 1b). This model provides both vessel-like softness to microsurgery trainees, and the needle passing through the center stabilizes this model.
    Also, it provides help to develop hand-eye coordination and to gain experience with the use microsurgical instruments under the microscope. This model can be used with 7.0, 8.0, 9.0 and 10.0
    suture materials. It can also be used as a simulation model in endto- end, end-to-side anastomosis and cases with vascular diameter mismatch (Figure 1c). In conclusion, after training on this model that costs only 40 cents, microsurgery trainees can learn easily on the animals.
    CONFLICT OF INTEREST

    The authors declare no conflict of interest.
    Keywords: Microsurgery training, simulation model, anastomosis