Microsurgery is a key element of reconstructive surgery, necessitating intensive training and a steep learning curve before being effectively performed1,2. Microsurgical skills can be applied to different surgical fields3, and the possibility to perform free tissue transfer, perforators dissection, nerve repair and lymphatic surgery has revolutionized the surgical management in the limb salvage, post-oncologic resections and lymphedema treatment, providing huge improvements in patients quality of life3. Microsurgical training has the aim to guarantee solid technical bases to young microsurgeons and boost their learning curve4. Unfortunately, despite the common agreement regarding the central role that such training has in the development of required skills, there is lack of realistic, cheap and easily available training models5.
We can divide described models in literature in three main groups: synthetic models, ex vivo models and live animal models, with crescent level of accuracy and fidelity. However, even if practicing on living animal models is considered the gold standard before clinical practice, 3 R principles (Replacement, Reduction and Refinement) are pushing towards the use of ethically sound, safe, feasible, and cost-effective initial training alternatives. Studies have shown that simulated training on low-fidelity models was effective in establishing microsurgical skills that can be later transferred to animal or cadaveric models.
Many synthetic training tools have been described to acquire the basic microsurgical techniques and maintain one’s hand dexterity during intervals of ineptitude.
This systematic review critically analyses literature regarding synthetic microsurgical devices, in order to evaluate those that can be considered an effective replacement of ex vivo or in vivo models, in terms of progression of dexterity and microsurgical skills. Moreover, this review wants to establish whether such devices could be used as evaluating tool to determine in a quantitative manner microsurgical dexterity and be used as evaluating devices to compare progression in microsurgical learning.