Learning Curve in Hemifacial Transplantation in Rats
M. Climov, M.B. Măciuceanu Zarnescu, A. Stefănescu, D. Zamfirescu, I. LascărOriginal article, no. 2, 2013
Introduction: The aim of this study was to emphasize the
learning curve of hemifacial transplantation in rats by
comparison between 2 operators: medical student trained in
basic microsurgery and an experienced microsurgeon.
Materials and Methods: A total number of 15 hemifacial
transplants between Brown Norway as donors and Wistar as
receiver rats were performed by two operators: experienced
microsurgeon (group II, n=5) and the medical student (group
III, n=10). Warm ischemia time and operative time were used
as instrument for comparison. All the rats received immunosuppressive
treatment with cyclosporine A in monotherapy for
30 days. Results were processed statistically using Microsoft
Excel.
Results: Transplantation procedure duration time performed by
experienced microsurgeon began from 420 min and decreased
to 330 min after 5 transplantations, with confidence interval
(95% probability) 382±37.9 min and the warm ischemia time
decreased from 140 min to 50 min, confidence interval of the
warm ischemia time being 90±33.52 min. After transplantation
the rats were treated with cyclosporine A and monitored
for 30 days. Medical student tended to equalize the operative
time and warm ischemia time, approximately, after 9 transplantations,
from 660 min to 330 min and warm ischemia time
from 190 min to 60 min. The confidence interval (95%) of the
procedure by duration of the surgery was 467± 80.66 min and
133.5±31.44 min for the warm ischemia time. Most of the rats
(n=11) survived in both transplanted groups (group II and
group III) performed by microsurgeon and student. By
analyzing learning curves using two parameters (operative time
and warm ischemia time) and survival rates no statistically
significant difference was found (p>0.05).
Conclusion: Hemifacial transplantation model in rats is a
useful tool for preparing experimental and clinical application
of the facial transplantation. It is a good model for training
young specialists for future transplantation surgery. It is
important to notice that the medical student had previous
experience in microsurgery and the learning curve was applied
only for this specific procedure. Even young specialists in
microsurgery could perform such a complex procedure after an
appropriate training period (in our study after 9 consecutive
transplantations) in the same fashion and with the same results
as an experienced microsurgeon. Usage of cyclosporine A as
monotherapy gave good immunosuppression results in rats’
transplantations for the studied duration of time (30 days).
