MI4 (Microsurgery Institute 4): Programme

Programme

Task: Round the clock

Task: In out up down

Task: All tied up

Task: Stars the limit

Task: Suturing at angles

Task: End is near

Programme.

The programme breaks down microsurgery into bite size chunks and basic elements. Trainees must reach a target score (figure 3) in the tasks in each stage before moving on to the next stage.

All trainees are advised to read the course material and are given a didactic session on the programme microsurgical techniques by an MI4 trainer. They then have a pre programme baseline microanastomosis assessment on a chicken femoral artery microanastomosis (chicken artery dissection). Once this is recorded they then go progress the steps.

Step 1 Needle Dexterity

Task: Round the clock- Target time: 46 seconds

Model structure: 8 sewing position in a clockwise manor in sponge.

Action: You are required to start at 12 o clock on the model face and pass a 8-0 nylon needle through the eye of each consecutive needle bearing in mind that they are at different heights

Task: In out up down- Target time: 4mins 40 seconds

Model Structure: Perforated dressing eg Mepitel TM sandwiched between two cardboard pieces with window .This is stapled in position and folded centrally and laterally to give an inverted V stable structure. Tape model to worktop to keep secure.

Action: start at one end of this model and pass an 8-0 nylon needle in and out through each perforations in the mepitel. First forehand from one end of the model horizontally to the opposite end, and then back hand.

Task: All tied up- Target time : 25 seconds each knot

Model Structure: Requires a cardboard piece, 2 safety pins, 2 rubber bands and tape. 2 holes are made in the card 8 cm apart and rubber band loops are passed through the hole and secured with a knot. These are for stabilising the little fingers. A further two holes are made 8 cm and 10cm from each finger hole. The safety pin looped ends are passed through the holes and secured with tape on the underside. See video below.

Action: Insert each little finger into the rubber band loops. Chose the hook most comfortable for the reach of your instruments. Tie an instrument tied knot in the centre of the hook with your hands held in the restricted position. The knot should be snug on the loop

Step 2 Economy of movement

Task: Stars the limit- Target time: 2 minutes seconds

Model structure: Create a stencil cutting a 5 mm limb length star. Use a surgical marker to draw the star on the grape using the stencil. Secure the grape with a needle in a cardboard box.

Action: Incise within the black line of a standard drawn star on a grape.Use dissecting scissors to peal the star of the flesh of the grape

You get 1 score for incising within the black lines: total = 10

You get 1 score for dissecting each limb without any flesh: total score = 5. (If there are any flesh remaining you will not receive a score. You will be deducted a score for every perforation created). Maximum score= 15

Task:Suturing at angles- Target time:7 minutes 30 seconds

Model structure: Cut a 15cm x 15 cm square on a cardboard tray. Cut a piece of latex glove 20cm x 20cm and secure with tape over the square window. Draw 4 lines each 1 cm long horizontally vertically forward angle and backward angle.

Action: Place two simple instrument tied knots

1. vertically forehand

2. horizontally forehand

3. top left to bottom right forehand angled

4. top right to bottom left back hand angled

Task: End is near- Target time: 45 seconds

Model structure: Use the model structure form suture at angles. When you are near the end of an anastomosis a loop stich allows you to tie two sutures in a short space.