This chapter trains your fine finger movements. In the previous chapters, we focused on planning, coordination, and rougher motor skills. With this exercise, we will expose you to microsurgery and your tremor. Unfortunately, microsurgery is often mystified as an elite field, which requires special gifts. There will of course be a small population of especially gifted people around us, but believe me, with motivation, some endurance, good teaching, and training, nearly everybody will be able to perform complicated microsurgical procedures. You can prove this to yourself by suturing a vessel with a diameter of less than 1 mm. No microvascular laboratory? No animal house? No instruments? No problem.
You just need five instruments, sutures, and a chicken wing.1
Relevance for your daily practice
Suturing small vessel is of virtually no practical relevance for your daily practice. However, the confidence in your skills that you will achieve by practicing with this model is very valuable and will support you if you (and that will happen) question your principle skills. On the other hand, maybe you will become so fascinated with this kind of surgery that you will become very interested in cerebral bypass surgery.
The objective of this exercise is to train your fine finger movements, provide you with confidence that you can do microsurgery, and test and train your endurance.
You need chicken wing, Dumont watchmaker forceps no. 5, surgical scissor 10.5 cm or scalpel no. 11, micro-scissor, 6.0-9.0 sutures, and needle holder (Fig. 6.1). These instruments are (if not available through your hospital) easy to order via the Internet (total costs around €200). You also need a microscope.
This exercise is feasible in the OR or in any office equipped with a microscope.
The setup of your workstation is possible in the OR or in any office where in which you can place a microscope. A table and a chair with adjustable height are important. Also take care to choose a table that is stable and provides enough place for a comfortable rest of your hands and underarms.
Adjust the heights of table and chair to reach a position of maximal relaxation and comfortable positioning of your underarms and wrists (Fig. 6.2).
Put the chicken wing on a suitable surface. We recommend using a board, which makes rotation of the surgical field easier. Make sure that the board is large enough to accommodate your forearms and especially the wrists.
The brachial artery runs between the palpable muscle bulks. Open the skin with the surgical scissor (Fig. 6.3a, b) in the direction of the assumed vessel course and separate the muscle bulks with blunt dissection. You will find the vessel bundle at the bottom of the sulcus.