LAUSR

Dear Editor, Acquisition of microsurgical skill requires considerable practice and has a steep learning curve. The advent of supermicrosurgery and its increasing utilization in lymphatic surgery introduces further skills in handling and anastomosis of ultra-fine neurovascular tissue. While live rat anastomosis remains the standard microsurgery training model, rising costs and ethical concerns have led to the development of a variety of non-living synthetic and animal models that offer the advantages of low cost and easy availability (Rodriguez, Yañez, Cifuentes, Varas, & Dagnino, 2016). Pigs have widely been used in surgical training and research as they provide a large animal with tissue structure that bears close resemblance to that of humans (Ito & Suami, 2015). Pig skin is regarded as equivalent to human skin with similar size, orientation and distribution of vessels making it most suitable for lymphatic research as well as microsurgical training (Ito & Suami, 2015; Suami & Schaverien, 2016). Suami and Schaverien developed a supermicrosurgical training model using the pig hind limb from the hip joint to digits, however, despite its recognition of high-fidelity, this method was criticized for being expensive and inconvenient, limiting its widespread use (Pafitanis, Narushima, Yamamoto, et al., 2018; Suami & Schaverien, 2016). We present a simplified supermicrosurgical training method using only the pig foot and readily available dyes to practice lymphaticovenular anastomosis (LVA). Pork trotters (pig feet) from the local supermarket are thawed. Using a 1 ml syringe, 0.05 ml indocyanine green or blue dye (methylene blue or gentian violet) is injected subdermal between the digits, and the limb is gently massaged. Lymphatic mapping is then performed using a nearinfrared camera, if available, and LVA sites marked (Figure 1a,b). A skin incision is made, and the lymphatics and venules identified following