Microsurgery is an art, and a well-sutured anastomosis is a masterpiece that can be achieved only by long and persistent training. Given its high cost in terms of finance, time, and labor,1 it is rather strange that usually microsurgeons do not preserve the results of their work; we could not find any relevant publications.
In this article, we want to fill this gap by proposing a simple and widely available method for the preservation of microanastomoses, and to discuss its advantages, disadvantages, and prospects.
After performing and assessing the quality of the microvascular or microneural anastomosis, it is isolated from the training model (chicken wing, rat, etc.), washed with water and placed in a “wishing bottle”—a small glass vessel with a volume of 1–25 ml, which can be easily found in craft stores.
Then, the bottle is filled with conservative fluid and closed with a cork. In our laboratory, we routinely use a saturated salt solution. The saturation point is achieved by dissolving 35.89 g of NaCl in 100 ml of tap water at 20°C.2 Saturated salt solution is harmless, extremely cheap, easy to handle, and very good at preserving the haptic and visual properties of the specimens.
It is advisable to attach to the bottle a label with important information: operator’s name, date, type of anastomosis, etc. Thereafter, the anastomoses can be periodically removed from the bottle for reassessment, educational demonstration, or for changing the fluid.
The exemplary specimens of microvascular bypasses, preserved by using our method, are shown in Fig. 1 and in the Supplemental Digital Contents 1 and 2. (See figure 1, Supplemental Digital Content 1, which displays (a) Microvascular end-to-side bypasses, conserved in a wishing bottle (volume: 3 ml) filled with saturated salt solution. (b) A single end-to-side bypass (⌀: 1 mm), 1.5 month after conservation. https://links.lww.com/PRSGO/B601.) (See figure 2, Supplemental Digital Content 2, which displays (a) Microvascular side-to-side bypasses, conserved in a wishing bottle (volume: 3 ml) filled by saturated salt solution. (b) A single side-to-side bypass (⌀: 1 mm), a month after conservation. https://links.lww.com/PRSGO/B602.)
In our opinion, the proposed conservation technique can facilitate the cultivation of regular microsurgical training. It is known that visual feedback is a powerful external motivator in reaching long-term goals, which enhances internal motivation.3 So, the already made and stored anastomoses provide a strong positive feedback that encourages the desire to train further. On the other hand, the absence of new anastomoses in the bottle also serves as a signal for the trainee for continuing exercises.
In addition, the proposed technique has the following advantages: ease of use, financial and ethical accessibility, portability, and the ability to demonstrate anastomoses and re-evaluate them. Finally, preserved works may acquire important aesthetic and historical significance in the future, like museum exhibits.
The limitations of this method are the fragility of the glass bottle and its nonabsolute tightness, which can lead to fluid evaporation. In addition, the solution becomes contaminated over time. This problem is easily solved by periodic replacement of the fluid.
In conclusion, we hope that the proposed technique will be useful for the development and popularization of microsurgical training among our colleagues.
1. Belykh E, Martirosyan N, Kalani Yashar M, et al. Microsurgical Basics and Bypass Techniques. 2020, New York, N.Y.: Thieme
2. Lombardero M, Yllera MM, Costa-E-Silva A, et al. Saturated salt solution: a further step to a formaldehyde-free embalming method for veterinary gross anatomy. J Anat. 2017; 231:309–317
3. Cheema A, Bagchi R. The effect of goal visualization on goal pursuit: implications for consumers and managers. J Mark. 2011; 75:109–123