Animals have been widely used as a training model for teaching microsurgery. However, unlimited access to the animal laboratory is not always possible, and increased scrutiny of the ethical use of laboratory animals is a major factor to consider when teaching microsurgery. In such situations, an alternative method is required for microsurgical training techniques, such as medical grading tubes, and surgical gloves. These alternative teaching tools provide an ideal training model and present an alternative for teaching microsurgical techniques. They are readily available and abundant in the laboratory. In addition, these alternative tools can be used to provide initial training before entering the clinical setting. A practice card designed from surgical gloves and medical grading tube was used to practice simple sutures. The training progressed to a more difficult level, using medical-grade tubing for end-to-end anastomosis, end-to-side anastomosis, side-to-side anastomosis, and free graft placement. This alternative proved challenging for the trainees, but improved hand coordination was observed. The alternative models familiarized trainees with the instruments and with developing a surgical approach before moving on to more clinical settings. The use of surgical gloves and medical grading tubes resulted in a significant reduction in the numbers of laboratory animals used for teaching microsurgery, as well as reduced cost.
Previous anatomic studies of the medial heel region were done on embalmed human cadavers. Here, the innervation of the medial heel region was studied by dissecting living tissue with the use of 3.5-power loupe magnification during decompression of the medial ankle for tarsal tunnel syndrome in 85 feet. The medial heel was found to be innervated by just one medial calcaneal nerve in 37% of the feet, by two medial calcaneal nerves in 41%, by three medial calcaneal nerves in 19%, and by four medial calcaneal nerves in 3%. An origin for a medial calcaneal nerve from the medial plantar nerve was found in 46% of the feet. This nerve most often innervates the skin of the posteromedial arch, where it is at risk for injury during calcaneal spur removal or plantar fasciotomy. Knowledge of the variations in location of the medial calcaneal nerves may prevent neuroma formation during surgery and provide insight into the variability of heel symptoms associated with tarsal tunnel syndrome.
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