Primary hyperhidrosis is a troublesome disorder of excessive perspiration that affects as much as 1 percent of the population. Sufferers are usually young and are often affected by related social, professional, and psychological problems. Many methods for treating hyperhidrosis exist; however, no single treatment is without its weakness or complications. This article aims to clarify the issues related to the use of each treatment modality, including the most recently proposed method using botulinum toxin.

How does one demonstrate competence in microsurgery? This will become an increasingly more important question as further reforms in surgical training and revalidation are implemented. Any assessment of competence should include an assessment of technical skill, but there is presently no validated objective assessment technique to do this. We examine the ideal characteristics of an assessment technique and review the methods currently being validated and which could be applicable to microsurgical skills.

Practical skill training courses are an increasingly popular method of teaching surgical skills. Few data are available from instructional courses indicating how successful they are at imparting practical skills to those individuals who attend them. We aimed to identify the skill benefits gained by trainee surgeons attending a 5-day microsurgical skills course. A global scoring system was devised to objectively assess the level of skill employed by trainees to complete an arterial microvascular anastamosis. Vessel patency, anastamotic construct, and care of tissue in the surrounding operative field were taken into account. Postoperative tissue viability and physiological vessel function following anastamosis were also investigated. The majority of surgeons (60%) exhibited an increase in their level of microsurgical skill during the course. The remaining candidates remained static or deteriorated. Attendance at this microsurgical training workshop resulted in an improvement in microsurgical skills in most trainees. In-course assessment by training courses would allow identification of individuals requiring further training or skill refinement.

Many microsurgical training models exist. These can be broadly classified into living and non-living. The latter type can be further sub-classified into non-vital, prosthetic, and virtual reality models. We review each model within these sub-groups with reference to the ideal properties of a training model. The most important attribute of any model is that the skills acquired from it must translate efficiently into microsurgical skill in the clinical situation. We believe that non-vital and prosthetic models are an important complement to living ones in training and maintaining the skills of all microsurgeons. As virtual reality technology improves, virtual models may succeed the rat as the microsurgical training tool of choice.

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