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Surgical Neurology 72 (2009) 695 – 699

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Technique
Microsurgical training on an in vitro chicken wing infusion model
Jon Olabe, MD⁎, Javier Olabe, MD, PhD
Department of Neurosurgery Hospital Universitario Son Dureta, 07014 Andrea Doria, Palma de Mallorca, Spain
Received 26 October 2008; accepted 9 December 2008

Abstract Background: Microneurovascular anastomosis and aneurysm clipping require extensive training
before mastering the technique and are a surgical challenge. We developed the “infused chicken wing
method” to provide a simple but realistic training method minimizing animal use and need for special
facilities for animal care and anesthesia.
Methods: Fresh chicken wings were used in this model. The main brachial artery was cannulated,
and water was infused at 140 mm Hg followed by anatomical neurovascular dissection. Multiple
microsurgical training exercises were performed under microscope vision including terminoterminal,
lateroterminal, laterolateral vascular anastomosis, and nerve anastomosis. Different complexity
aneurysms were created using venous patches, clipping, rupture, and vascular reconstruction
techniques were performed.
Results: This novel training model is inexpensive, easily obtainable, and no live animals are
required. The diameter and characteristics of arteries and veins used are similar to those of the human
brain. Great microsurgical technique progress may be obtained.
Conclusions: The infused chicken wing artery model presents a realistic microvascular training
method. It is inexpensive and easy to set up. Such simplicity provides the adequate environment for
developing microsurgical technique.
© 2009 Elsevier Inc. All rights reserved.
Keywords: Aneurysm; Chicken wing; Infusion; Microsurgery; Training model; Vascular

1. Introduction method” to provide a simple and cheap but realistic training

method minimizing animal use and need for special facilities
Microneurovascular anastomosis and aneurysm clipping
for animal care and anesthesia.
require extensive training before mastering the technique and
are a surgical challenge. Hands-on laboratory procedures are
essential being a learning tool for young surgeons and a daily 2. Methods
exercise for the more experienced. Training typically has
Fresh chicken wings were used in this model. The main
been done with artificial materials such as silastic tubes and
brachial artery was cannulated with a 24G Introcan gauge (B.
gloves, dead specimens such as chicken wing and turkey
Braun Medical, Germany) fixing it with 4-0 silk suture.
neck, or on live animals being these the most realistic but
Saline solution, 0.9%, was infused at 140 mm Hg using
needing a specific environment with special care and
serum infusor (Infusor, Statcorp, Jacksonville, FL, USA).
anesthesia. Several in vitro models have been developed
Anatomical neurovascular dissection (Fig. 1) using standard
simulating in vivo situations [1-14], some even with blood
microsurgical instruments (Aesculap, Tuttlingen, Germany)
perfusion through harvested arteries or pulsatile perfusion
was then performed under microscope magnification (Zeiss
using pumps. We developed the “infused chicken wing
Opmi 1, Carl Zeiss, Madrid, Spain). Angiographical study
was performed for better understanding of anatomy (Fig. 2).
⁎ Corresponding author. Tel.: +34 630587273. Multiple microsurgical training exercises were performed
E-mail address: jonolabe@hotmail.com (J. Olabe). including terminoterminal, lateroterminal, laterolateral vas-
0090-3019/$ – see front matter © 2009 Elsevier Inc. All rights reserved.
doi:10.1016/j.surneu.2008.12.008
696 J. Olabe, J. Olabe / Surgical Neurology 72 (2009) 695–699

Fig. 1. Anatomical dissection of the chicken wing.

cular anastomosis, and nerve anastomosis using monofila- 3. Results

ment 10-0 Ethicon nylon sutures (Johnson and Johnson,
Somerville, NJ, USA) (Fig. 3). Different complexity
aneurysms were created using venous patches, clipping
with Sugita neurosurgical clips (Mizuho, Tokyo, Japan),
rupture, and vascular reconstruction techniques were per-
formed (Figs. 4 and 5).
The diameter and characteristics of arteries and veins used
are similar to those of the human brain. Anatomical
neurovascular dissection of the infused chicken wing model
provides a good working field for multiple microsurgical
training exercises. Technical progress was rapidly noted by the

Fig. 2. Chicken wing angiography.

 J. Olabe, J. Olabe / Surgical Neurology 72 (2009) 695–699
Fig. 3. A: Arterial terminoterminal anastomosis. B: Arterial lateroterminal anastomosis. C: Arterial laterolateral anastomosis. D: Arteriovenous terminoterminal
anastomosis. E: Arteriovenous lateroterminal anastomosis. F: Nerve terminoterminal anastomosis.
trainees. A standard training session including setup, initial
dissection, 2 anastomosis, 1 aneurysm creation with clipping,
and cleaning the apparatus takes 90 minutes.
4. Discussion
Microsurgical laboratory training must be a daily routine
for neurosurgeons. Time is usually scarce so a simple,
accessible, cheap, and fast setup method is needed. Our
model provides all these characteristics being very time
efficient and user friendly thus encouraging the trainee to
exercise frequently.
The main disadvantage of this model with respect to in
vivo situation is difficulty for measuring chance of thrombosis
as well as lack of pulsatility. Suture leakage is also greater so
the trainee tends to place extra unnecessary sutures. The
serum infused ends up filling the interstitial space leaking into
the surface making intermittent suction necessary.
The infused chicken wing artery model presents a realistic
microvascular training method. It is inexpensive and easy to
set up. Such simplicity provides the adequate environment
for developing microsurgical technique.
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Fig. 4. A: Aneurysm 1 clipping. B: Aneurysm 2 clipping. C: Ruptured aneurysm 3 clipping.

 J. Olabe, J. Olabe / Surgical Neurology 72 (2009) 695–699 699

Fig. 5. A: Complex bifurcation aneurysm with artery arising from dome. B: Clipping option 1. C: Clipping option 2. D: Clipping option 3, neck clipping, and
terminolateral anastomosis.