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Clinical management of vestibular schwannomas (VS) encompasses three main strategies: observation ("wait-and-scan"), stereotactic radiosurgery, and microsurgery. Despite extensive literature, a consensus on the optimal modality is lacking due to the scarcity of high-level evidence. This narrative review explores the current understanding of the most significant clinical and radiographic outcomes following wait-and-scan, radiosurgery, and microsurgery. This is not a systematic review of the literature. Observational studies indicate that approximately one-third of tumors demonstrate growth within 3 years, and approximately 40% of patients eventually require active treatment. Radiosurgery achieves high long-term control, with radiological control exceeding 90% and clinical control above 95% at 10 years. However, hearing preservation is variable and time-dependent. Microsurgery can achieve gross total tumor removal and high long-term tumor control, with reported recurrence rates below 2% following gross total resection. However, recurrence estimates vary according to follow-up methodology and definitions of recurrence. Risks of hearing deterioration and facial nerve impairment increase with tumor size and extent of resection. Comparative studies, largely nonrandomized, suggest that radiosurgery offers better hearing and facial nerve outcomes than microsurgery in small- to medium-sized tumors. Quality-of-life assessments show little difference among treatment modalities. The V-REX trial remains the only randomized study to date, showing that upfront radiosurgery reduces tumor volume but does not yield superior clinical outcomes compared with observation. The current evidence is dominated by retrospective case series with heterogeneous methodologies. Prospective, randomized controlled trials (RCTs) are critically needed to guide superior treatment strategies and enhance patient care.

Normal root formation depends on the developing apical complex (DAC), which coordinates root and periodontal tissue development. Root-like apical hard-tissue development is a rare odontogenic finding that has been reported in association with developmental disturbances, trauma, and inflammatory conditions. This case report describes a 15-year-old male presented with pain in the lower right premolar (tooth 45). Cone-beam computed tomography and histopathological revealed chronic periapical periodontitis associated with a root-like apical hard-tissue structure containing a central radiolucent canal-like space. The lesion was managed with root canal therapy and endodontic microsurgery, resulting in a favorable outcome without complications during the 12-month follow-up period. This case illustrates a rare root-like apical hard-tissue structure associated with chronic apical inflammation. Although the radiographic and histopathological findings were compatible with previously reported cases of segmental root development, the exact developmental origin of the lesion could not be determined. The findings contribute to the clinical characterization of a rare root-like apical hard-tissue anomalies and emphasize the importance of careful radiographic and histopathological evaluation. Combined root canal therapy and endodontic microsurgery resulted in a favourable clinical outcome in this case.

Wide Awake Local Anesthesia No Tourniquet (WALANT) is often introduced as an anesthetic technique that avoids general anesthesia, regional blocks, sedation, and tourniquet discomfort. This description is accurate, but incomplete. The deeper significance of WALANT is that it restores living physiology to the operating theatre. For more than a century, reconstructive surgeons repaired tendons, transferred nerves, corrected deformities, balanced muscles, and reconstructed movement in patients whose physiology was temporarily silent. Tendon tension was estimated, nerve function was predicted, muscle balance was assumed, and the final judgment of success was delayed until rehabilitation revealed the truth. WALANT challenges this old paradigm by allowing movement, tension, balance, spasticity, sensory response, and patient-specific biomechanics to be observed during surgery itself. Its expanding role in tendon transfer, thumb reconstruction, peripheral nerve surgery, brachial plexus reconstruction, spasticity surgery, and ambulatory microsurgery suggests that its greatest contribution may not be anesthetic freedom, but the birth of physiology-guided reconstruction. This editorial argues that WALANT has moved beyond tendons and beyond anesthesia. It has become a new way of thinking about reconstructive surgery.

Variations of the upper-limb venous system are relatively common; however, complex segmental venous drainage patterns associated with neural variations remain exceptionally rare. Detailed knowledge of these anatomical configurations is clinically important because the basilic and brachial veins are frequently involved in vascular access procedures, venous catheterization, reconstructive microsurgery, and axillary surgery. The present cadaveric case report describes a rare neurovascular variation identified during routine educational dissection of the left upper limb of a 75-year-old male donor. The variation consisted of triple independent segmental drainage of the brachial veins into the basilic vein, resulting in a non-classical multilevel formation of the axillary vein. The first brachial vein drained into the basilic vein at the middle third of the arm, the second near the origin of the ulnar nerve, and the third near the formation of the median nerve. Additionally, the median nerve demonstrated a variant formation consisting of two lateral roots and one medial root. Of particular anatomical and clinical significance, the third brachial vein coursed anterior to the medial root of the median nerve before draining into the basilic vein. The coexistence of multiple venous and neural variations resulted in a complex neurovascular arrangement in the axillary region. Such anatomy may increase the risk of hemorrhagic or neural complications during venous catheterization, brachiobasilic arteriovenous fistula creation, axillary lymph node dissection, brachial plexus exploration, and reconstructive vascular procedures. Particular caution may be warranted during ultrasound-guided venous cannulation, peripherally inserted central catheter placement, and brachiobasilic fistula transposition. The present case highlights the importance of recognizing rare combined neurovascular variations and performing careful preoperative vascular mapping to minimize complications during upper-limb surgical and interventional procedures.

Primary thinning of bulky flaps in high-body mass index patients remain a significant challenge in reconstructive microsurgery. Aggressive defatting risks compromising the linking vessels between the subdermal and suprafascial plexuses, leading to flap marginal necrosis. Consequently, one-stage thinning of large, fatty flaps is generally discouraged. A new three-step technique was applied in eight consecutive patients undergoing free flap transplantations between August and October 2025. The procedure consisted of: suprafascial flap elevation; radial fasciotomy (incision of the superficial fascia) around perforators; and manual extrusion of fat granules, performable before or after pedicle division. Flaps were thinned to a target fat layer thickness of <0.5 cm. Operative time for flap thinning, intraoperative vasospasm (>5 minutes), and postoperative complications were assessed. All eight flaps were successfully thinned to an ultra-thin state (<0.5 cm) within 20 minutes. No vascular branches required sacrifice during manual extrusion. No lasting vasospasm or postoperative complications (e.g., vascular compromise, partial necrosis, or skin ecchymosis) occurred. All flaps survived completely. This novel approach enables safe, efficient, single-stage flap thinning while preserving sensation, even in obese patients. It represents a significant advance that merits further validation through larger comparative studies. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Sickle cell trait (SCT) is considered a benign carrier state. Though not associated with vaso-occlusive crises of sickle cell disease (SCD), physiological stress like hypoxia, hypothermia, and sympathetic activation experienced during surgery can lead to sickling in patients with SCT. Some reports suggest that perioperative sickling may lead to thrombosis or flap loss. In the context of microsurgery, SCT is assumed to pose less risk than SCD due to lower hemoglobin S (HbS) levels. This study aims to characterize microsurgical outcomes in patients with SCT. We identified a series of patients with confirmed SCT who underwent microsurgical free flap reconstruction at one institution. Patient demographics, flap type, perioperative factors, postoperative complications, and overall flap survival were analyzed. Six free flaps were identified in five patients with sickle cell trait, including 4 DIEP flaps, 1 ALT flap, and 1 RFFF. All flaps survived with an average follow-up of 9.5 months. Four of six flaps (67%) experienced postoperative complications, including seroma (n = 1), donor site hematoma (n = 2), and wound dehiscence (n = 1). One patient developed venous thrombosis on postoperative day 1 requiring re-anastomosis. All but one maintained normothermia and adequate oxygenation. Preoperative hemoglobin averaged 11.1 g/dL, decreasing to 9.2 g/dL postoperatively, without transfusion. Despite concern for sickling events, this series of patients with SCT appear to tolerate free flap reconstruction. Even with transient intraoperative hypoxia and hypothermia, flap viability was preserved. Larger studies are needed to define microsurgical risk in SCT patients, particularly in relation to HbS levels and comorbidities.

The intersection of art and orthopaedic surgery represents a profound synthesis of technical precision, aesthetic sensibility, and humanistic care. This narrative review examines the artistic dimensions of orthopaedic surgery, with particular emphasis on hand and upper extremity procedures in which form and function are inextricably linked. We trace the historical evolution of surgical artistry from Renaissance anatomists and craftsmen, including Ambroise Pare, whose articulated prosthetic hands united the ingenuity of locksmiths with the vision of surgeons, through nineteenth-century operative theatre culture, in which surgical skill was evaluated for its elegance and grace as much as its outcomes, to modern microsurgery and the age of robotics. Drawing on a systematic review of peer-reviewed sources spanning anatomy, reconstructive surgery, outcomes research, and the philosophy of craft, we analyse the application of core artistic principles, proportion, symmetry, harmony, rhythm, and balance, to surgical practice, demonstrating that these concepts provide a functional framework for operative decision-making, technique selection, and outcome evaluation. The surgeon's role extends beyond technical competence to encompass aesthetic judgment, creative problem-solving, spatial visualisation, and an appreciation for the beauty inherent in anatomical restoration. Specific techniques in hand and upper extremity surgery are examined as case studies of artistic principle applied to clinical practice: toe-to-hand microsurgical transfer, soft-tissue flap coverage, fingertip and nail reconstruction, scar management, rheumatoid hand reconstruction, and congenital deformity correction each illustrate how aesthetic refinement and functional restoration are not competing objectives but mutually reinforcing goals. Patient-reported outcomes related to aesthetic satisfaction are evaluated through validated measures including the Patient and Observer Scar Assessment Scale (POSAS), with evidence confirming that hand appearance constitutes a significant determinant of patient satisfaction, psychological well-being, and quality of life (QoL). The education of the surgeon's hand, through apprenticeship, deliberate practice, and embodied tactile experience with instruments, is identified as an irreplaceable component of surgical formation that no technological advance can render obsolete. We conclude that excellence in orthopaedic surgery demands mastery of three interrelated domains: scientific knowledge, technical skill, and artistic sensibility. Future directions include the formal integration of aesthetic training into surgical curricula, development of objective aesthetic outcome metrics, expanded use of three-dimensional imaging for aesthetic planning, and institutional recognition of the artistic dimensions of surgical practice as essential components of comprehensive, patient-centred care.

Pediatric brain arteriovenous malformations (AVMs) have higher recurrence rates than adult lesions, yet the long-term durability of transvenous embolization (TVE) in children remains poorly defined. We therefore evaluated long-term clinical and angiographic outcomes after curative TVE for ruptured pediatric AVMs. This multicenter retrospective cohort comprised 12 pediatric patients (older than 18 years) treated with curative TVE from 2012 to 2025. Angiographic cure was defined as complete obliteration on 6-month digital subtraction angiography (DSA). Long-term surveillance included annual MRI/magnetic resonance angiography, with confirmatory DSA if recurrence was suspected. Complete angiographic obliteration was achieved in all patients at 6 months. Over a mean follow-up of 103 &#xb1; 39 months, no delayed hemorrhages occurred. Late AVM recurrence was identified in 2 patients (17%) after documented angiographic cure and was detected only on delayed imaging surveillance. One recurrence involved a lesion with previous superficial venous drainage, whereas the other occurred in a lesion with deep venous drainage. Both were successfully retreated endovascularly without added morbidity. TVE provides durable hemorrhage control in selected pediatric AVMs; however, late recurrence may still occur despite early angiographic cure. These findings confirm that TVE is no exception to the well-documented late recurrence rate of pediatric AVMs across all treatment modalities, reinforcing that prolonged imaging surveillance is as essential after TVE as after microsurgery or radiosurgery.

To perform a systematic review about microsurgical training for medical students. A systematic search was conducted in several databases. Screening was performed by two independent reviewers based on predetermined criteria, following PRISMA 2020 guidelines. A total of 433 articles were obtained. After screening, 40 were included. Teaching methods were heterogeneous and restricted to a few countries. There are specific methods to assess microsurgery training, general surgical activities, learning curve and anxiety. The most used materials were surgical gloves, silicone tubes, chicken thighs and rats. Animals were not essential in early stages of education. There was a variation between one and 24 sessions regarding teaching frequency and between 3 and 120 hours of teaching period. The average age of students was 23.7, and 67.5% were men. Teaching groups had an average of 5.8 students per group. Physical activity and anxiety had negative effect on microsurgical ability gain, while caffeine had positive effect. Alcohol and sleep deprivation had no significant effect. Students with adequate training could achieve performance similar to that obtained by experts. Microsurgical education is realistic during medical graduation and may enable better career choices. More investigations are needed to improve this training and expand knowledge to other medical schools.

In the current endovascular era, only a minority of intracranial aneurysms (IA) are treated surgically. This study aims to delineate the contemporary indications and outcomes of open microsurgical treatment. Retrospective single-center analysis of patients treated for IA between 2019 and 2023, including ruptured and unruptured cases. Our center follows an "interventional-first" strategy, reserving surgery for aneurysms deemed unsuitable for endovascular therapy. For each surgical case, the reason for endovascular unsuitability and the corresponding outcome were assessed. A total of 432 aneurysms were analyzed, of which 39.1% were treated with open surgery and 60.9% with endovascular therapies. In the surgical cohort (140 patients, 169 treated aneurysms), 41.4% of cases presented with subarachnoid hemorrhage. The main morphological reasons for selecting open surgery were wide-necked aneurysms (27%), branch incorporation at the neck (19%), and very small aneurysm size (<3&#x2005;mm) (8.6%). A substantial proportion of bystander aneurysms (17.2%) were treated surgically because the index aneurysm required open surgery, allowing simultaneous treatment. Prior endovascular treatment had been performed in 15.7% of surgical cases. Adjunctive techniques to clipping, including anterior or posterior clinoidectomy, were necessary in 9.3% of cases. Cerebral bypass and trapping were required in 5.7% of cases, typically for large, calcified aneurysms with stenotic parent arteries. Complete aneurysm occlusion was achieved in 93.3% of cases. Major and minor complication rates were 3.6% and 7.9%, respectively. This study outlines contemporary indications for open surgery in the endovascular era and supports the complementary role of microsurgery within an integrated treatment strategy. Microsurgical treatment achieved high rates of complete aneurysm occlusion with acceptable morbidity, even in complex and previously endovascularly treated lesions. Careful patient selection and the use of adjunctive skull base and bypass techniques remain essential.

Artificial intelligence (AI) is transforming neurovascular surgery by improving diagnostic accuracy, risk prediction, treatment planning, and patient outcomes. This narrative review examines AI across the continuum of cerebrovascular care, from initial diagnosis through intervention and long-term prognostication. We discuss how machine learning, deep learning, computer vision, and natural language processing are applied to diverse data sources including neuroimaging, electronic health records, and intraoperative inputs. AI algorithms augment clinical expertise in diagnosis by delivering high speed and precision for tasks such as detecting large vessel occlusions, characterizing aneurysm morphology, and differentiating hemorrhage subtypes. Beyond detection, AI models are increasingly used for risk stratification-predicting aneurysm rupture, functional recovery after stroke, and post-intervention complications. AI also shows promise in therapeutic decision-making through pre-operative simulation, robotic-assisted microsurgery, and intraoperative guidance systems, with preliminary evidence suggesting potential improvements in procedural safety and efficacy (though most intraoperative AI studies remain at the proof-of-concept or single-center retrospective stage). Despite these developments, challenges remain, including algorithmic bias, limited generalizability, lack of interpretability, data privacy concerns, and regulatory barriers. Successful deployment requires seamless workflow integration and a clear understanding that AI assists, not replaces, the neurosurgeon. The convergence of AI with precision medicine holds promise for personalized, data-driven care through synergistic human-AI collaboration.

Endovascular embolization has historically complemented microsurgery or stereotactic radiosurgery for brain arteriovenous malformations (bAVMs), but advances in imaging, devices, and technique have enabled its use as a stand-alone curative therapy in selected patients. Data from resource-limited settings remain limited. We report a 10-year single-center experience with stand-alone curative embolization in a middle-income country and identify factors associated with angiographic cure. We performed a retrospective cohort study of adults with bAVMs treated with curative-intent embolization at a tertiary center in Lima, Peru (2014-2024). Treatment strategy (transarterial, transvenous, or combined) was individualized. Baseline clinical, angiographic, and procedural variables were collected. The primary outcome was complete angiographic obliteration. Secondary outcomes included intraprocedural complications, postprocedural intracranial hemorrhage (ICH), and mortality. Logistic regression analyses identified predictors of outcomes. Among 184 patients (median age 37 years, 55 % women), 64.7 % presented with rupture. Complete obliteration was achieved in 67.4 % overall, improving from 44.4 % in 2014-81.4 % in 2024. Smaller nidus size and fewer arterial feeders were strongly associated with cure, whereas larger size and greater feeder number independently predicted treatment failure. Intraprocedural complications occurred in 8.7 %, particularly in higher Spetzler-Martin grades. Postprocedural ICH occurred in 15.8 % and was associated with increasing feeder number. Mortality was 3.5 %. Stand-alone curative embolization is feasible and effective in carefully selected bAVMs, especially those with favorable angioarchitectural features. Prospective comparative studies are needed to define its optimal role in bAVM management.

This study applied a skill decomposition approach to identify and quantify technical nuances of performing subtasks of a microvascular anastomosis by analyzing suturing maneuvers, the duration of each step, and technical insufficiencies in a controlled setting. Four microneurosurgery trainees performed 16 end-to-side microanastomoses, alternating between the interrupted technique (IT) and the continuous technique (CT) of suturing on standardized artificial vessels. At the subtask level, 24 reproducible suturing techniques and 42 technical insufficiencies were identified and analyzed. Significant contributors to faster suture included biting both walls in a single move, dominant-hand suturing, and suturing directed toward the participant. Total anastomosis time correlated negatively with the sequential attempt order (p < 0.05) and correlated positively with the total number of technical insufficiencies (p < 0.05). The CT was 19% faster than the IT (mean [standard deviation (SD)], 15.7 [3.7] vs. 19.1 [4.7] min, p = 0.02). The IT was associated with 40% more technical insufficiencies per anastomosis than the CT (mean [SD], 37 [23.3] vs. 26.5 [12.2], p = 0.04). The CT throws were associated with insufficiencies related to controlling the suture thread, whereas the IT was associated with insufficiencies related to knot tying. By converting well-known microsurgical concepts into measurable performance subtasks, the skill decomposition approach offers a foundation for objective skill assessment and targeted training intervention. Identified maneuvers and insufficiencies that influenced the anastomosis subtasks form the foundation for evidence-based microsurgery training. A better understanding of the most effective microsurgical suturing techniques will contribute to their refinement, improving anastomosis quality and decreasing performance time.

Traumatic injuries of the brachial plexus are life-altering, associated with complex injury patterns and commonly affect young people. Since the introduction of brachial plexus microsurgery, studies have largely focused on improving motor outcomes without patient-reported outcome measures. To assess the development of quality of life after surgical treatment for traumatic injuries of the brachial plexus in addition to neurological outcome. This retrospective study investigated neurological outcome and health-related quality of life in 98 patients treated at Ulm University, District Hospital G&#xfc;nzburg between 1st January 2020 and 31st December 2023. EQ-5D-5L-, PainDetect- and two items of the PSQI-questionnaire were sent to all patients regarding their state before surgery and at last follow-up. Clinical data were gathered by chart review. 62 patients returned the questionnaires. Mean follow-up was 22.3 months. MRC grade 2/5 or more was achieved in 59.5% of musculocutaneous nerve, 61.9% of axillary nerve and 54.8% or suprascapular nerve reconstructions. Mean health utility index increased from 0.41 (standard deviation&#x202f;&#xb1;&#x202f;0.34) to 0.57 (&#xb1;0.28) (p&#x202f;<&#x202f;0.05) correlating with motor improvement (Spearmans's Rho 0.34, p&#x202f;<&#x202f;0.05). PainDetect scores showed a significant reduction of mean values from 19.7 (&#xb1;9.0) to 16.5 (&#xb1;8.0) (p&#x202f;<&#x202f;0.05). Sleep duration and quality showed a non-significant trend towards improvement. Brachial plexus surgery offers an invaluable possibility to improve patients' lives and a vital and oftentimes sole therapeutic opportunity for commonly young patients suffering from a profoundly life-altering condition.

The vascularized corticoperiosteal medial femoral condyle flap is widely used in reconstructive microsurgery; however, intraoperative perfusion frequently differs from static anatomical expectations. Despite widespread clinical use, quantitative data on descending genicular artery perfusion territories and functional behavior of inter-perforator connections under controlled perfusion conditions remain limited. Twenty fresh, unfixed human lower extremities underwent selective arterial cannulation and controlled sequential perfusion in a standardized ex-vivo model. A stepwise perfusion protocol (synchronous, isolated, and flow-reversal conditions with controlled proximal inflow and distal occlusion) was used to characterize territorial perfusion behavior and perforator morphometry. Perforator morphometry was recorded, and inter-perforator connectivity was classified according to perfusion response patterns rather than histophysiological confirmation. The descending genicular artery was consistently present and gave rise to saphenous, muscular, and articular branches, with relevant branching variability observed. In 30% of limbs, one of these branches-most frequently the saphenous-originated independently from the femoral artery, indicating relevant variability for pedicle planning. Under synchronous perfusion, the mean perfused cutaneous territory measured 312.6&#xa0;cm&#xb2; (210.6-415.6&#xa0;cm&#xb2;). Ninety-eight cutaneous perforators (4.9&#xa0;&#xb1;&#xa0;1.1 per limb) were identified; mean diameter was 0.70&#xa0;&#xb1;&#xa0;0.24&#xa0;mm with pedicle length of 3.6&#xa0;&#xb1;&#xa0;0.8&#xa0;cm, indicating consistent anatomical availability for flap harvest. These findings indicate that the descending genicular artery behaves as a dynamic perfusion field rather than a fixed angiosome and should be interpreted intraoperatively as a condition-dependent vascular territory, with implications for skin paddle design and flap planning.

Craniocervical junction (CCJ) arteriovenous fistulas (AVFs) are rare vascular malformations and are characterized by complex angioarchitecture and variable clinical presentation. The most common manifestations are subarachnoid hemorrhage and venous hypertensive myelopathy, with hemorrhagic presentation more often associated with ascending intradural or intracranial venous drainage, venous varices, aneurysmal structures, and spinal arterial feeders. Because the natural history remains incompletely defined, accurate angiographic characterization is essential for classification and treatment planning. Microsurgery remains the main treatment for most CCJ AVFs because of its high obliteration rate and durability, whereas endovascular treatment is useful in selected anatomically favorable lesions but may be limited by incomplete occlusion, recurrence, and ischemic risk in complex cases. Prognosis depends on presentation, lesion subtype, venous drainage pattern, age, baseline neurological status, timing of diagnosis, and treatment-related complications; hemorrhagic onset generally has a better outcome than venous hypertensive myelopathy. Structured angiographic follow-up remains important after treatment.

To evaluate the real-world reliability, safety, and effectiveness of a novel platform for robotic microsurgery when used to assist with microsurgical anastomoses. The physical demands associated with advanced supermicrosurgical techniques strain human limitations. The Symani Surgical System&#xae; is a robotic platform designed to support these challenging procedures with extreme motion scaling, tremor reduction, and miniaturized, wristed instruments. This was a non-randomized, multicenter, post-market clinical follow-up study (NCT04843436) evaluating use of Symani for microsurgical anastomosis in adults (age 18+) requiring free-flap (FF), nerve-repair, or lymphovenous anastomosis (LVA) procedures. Cases were enrolled both prospectively and retrospectively. The primary endpoints were robotic-procedure technical success and incidence of procedure-associated complications. Key secondary endpoints were subjective usability, intraoperative patency, and FF viability at discharge. Between May 2021 and February 2025, 412 patients at 10 sites underwent at least one microsurgical robotic anastomosis. The procedure technical success rate was 94.1% (507/539 robotic anastomoses; 95% CI: 91.7%-95.9%). Freedom from device-related events was 99.8%. Intraoperative patency at first attempt was 91.7% for FF (331/361, 95% CI: 88.3%-94.3%) and 96.2% (225/234, 95% CI: 92.8%-98.2%) for LVA. Intraoperative revision rates were 8.4% for FF (31/367, 95% CI: 5.8%-11.8%), 3.4% for LVA (8/234, 95% CI: 1.5%-6.6%), and 0% for nerve repair (95% CI: 0.0%-26.5%). FF survival at discharge was 97.8% (268/274, 95% CI: 95.3%-99.2%). The study results support the safety, reliability, and efficacy of Symani when used for robotic-assisted, microsurgical reconstructions.

Microsurgical training has traditionally relied on live animal models. While these offer high anatomical and functional fidelity, their use raises increasing ethical, logistical, and economic concerns and alternatives are needed. We conducted a prospective observational study to assess the subjective and objective validity of a pump-perfused chicken thigh model for microsurgical training. Forty-five residents and surgeons were categorized by microsurgical experience. Thirteen participants underwent motion analysis and blinded video-based scoring. All participants performed arterial end-to-end anastomoses. Face and content validity were evaluated by experienced participants using Likert-scale questionnaires, while construct validity was assessed by comparing operative performance, Stanford Microsurgery and Resident Training scoring (SMaRT) and motion parameters across experience levels. Face and content validity scores were high, with median values of 7.9 (IQR 7.3-8.3) and 8.8 (IQR 6.4-9.0), respectively. Construct validity was demonstrated by significant improvements with experience, including faster operative times (p = 3.05&#xd7;10-6, &#x3b5;&#x223c;0.59), higher success rates and fewer leaks (p = 1.41&#xd7;10-5, V(Cramer)&#x223c;0.56). Experts displayed smoother, more stable hand movements (lower jerk, tremor, and rotational instability); SMaRT scores effectively distinguished experts from non-experts (p = 0.0014 (r = 1)), and correlated moderately with motion metrics, suggesting complementary roles of expert video assessment and motion analysis in evaluating microsurgical performance. Qualitative differences in motion profiles and gesture structure were apparent between novice and expert participants. The perfused chicken thigh model is a realistic and ethical alternative for microsurgical training with robust face, content and construct validities. Motion analysis might provide an objective complement to expert video-based assessment, suggesting its interest in structured training programs.