LAUSR

Dear Editor, Supermicrosurgery, a technique of anastomosis small vessels ranging from 0.3 to 0.8 mm, has revolutionized the field of lymphedema surgery and refined reconstructive surgery. First chicken thigh (Chen et al., 2014), and now chicken wing are well accepted nonliving animal models for supermicrosurgery training with multiple advantages compare to synthetic or living animal models. Low purchase price, easy storage, reduced preparation time, convenient disposal, biological similarity, and absence of ethical issue have made them sustainable solutions (Kang, Jeon, Lee, & Mun, 2017). Chicken mid and lower wing dissections have been reported (El-Bably & Rezk, 2014) and have found extremes vessel's sizes between 1.01 0.21 mm (ulnar vein) to 0.36 0.07 mm (medial subcutaneous vein of the lower wing) (Hayashi, Hattori, Yii Chia, Sakamoto, & Marei, 2018). In our hands, we found unfortunately limitations to target and prepare very small vessels under 0.40 mm by the very nature of the model. There is a lack of hemodynamic circulation and thrombus formation in the lumen of these very small vessels, leading to poor contrast between their thin vessel walls and the surrounding subcutaneous tissue (Couceiro, Castro, Tien, & Ozyurekoglu, 2015), making the dissection even more challenging. In this article, we propose an economic, easy to use, fast and efficient technique to help surgeons to precisely and expeditiously target and prepare any small vessel of interest, by the realization of a global enhancement of the chicken wing's vascular system with a preoperative proximal intravascular injection of diluted Indocyanide Green (ICG) without the need for an ICG camera. Vessels will be seen even below the skin, before any incision. ICG is easy to access in a busy supermicrovascular lymphedema department because ICG lymphography is becoming popular. The price of ICG in Japan is approximately 8 euros, and 1 flask of ICG allows about 25 dissections. We used a needle of 27 gauze, secured on an insulin syringe containing diluted ICG (with 20 mL of saline) to