High-Fidelity, Low-Cost Microvascular Training Clamps: Expanding Training Opportunities for Microsurgery.

Abstract

Background: One significant barrier to training and supporting microvascular surgeons is the cost of obtaining high-quality equipment, particularly in resource-limited environments. Currently available synthetic solutions lack the durability to allow for resterilization with limited long-term durability. The authors aimed to develop and describe a reproducible process of creating low-cost, high-fidelity microvascular clamps that can be self-manufactured to improve access to microsurgical training and education worldwide.

Methods: Using 18-8 stainless steel sheets, templates were cut using a laser cutter (Fig. 1). Using a combination of needle nose pliers and a custom 3D-printed crimping tool, the template was folded on itself to fashion the micro clamp (Figs. 2, 3). The training clamps were then compared to standard Acland clamps using a constant pressure simulator and a force sensitive resistor to determine ability to impede flow as well as to ensure no excess force was applied to create trauma on the vessels. A cost analysis between conventional Acland microvascular clamps and training clamps was performed. A fidelity questionnaire was administered to a focus group of plastic surgery residents to assess training clamp performance relative to standard Acland clamps.

Results: No significant differences were found between the force applied from conventional Acland clamps and the training clamps. Training clamps were consistently able to occlude flow up to 160 mm Hg. The focus group found no significant differences in device handling, ease of use, or feel between the products. The cost to create each training clamp was $4.13, whereas Acland clamps cost ~$50 to purchase from the manufacturer. The average folding time was just under 5 minutes.

Conclusions: Using a single sheet of stainless steel and a crimping tool, single and double-opposing microvascular clamps can be created with reproducible design that is low cost, with high-fidelity, and can be manufactured by microvascular surgeons in resource-limited environments. Supplies can easily be shipped around the world and assembled. The stainless steel used to create these clamps is amenable to conventional sterilization methods and projected long-term durability. Further study is required to determine safety and device longevity for use in human populations.