Objectives: Flexor tendon suture requires a high level of surgical skills, and repeated training is important for young surgeons to acquire sufficient techniques. Presurgical trainings using supplementary materials have been recommended from the viewpoint of medical ethics, although senior surgeons had obtained their surgical skills through “on the job training.” However, there have been few reports on training programs using supplementary materials. To acquire optimal surgical skills, we have established an original training program of tendon suture for the residents using pettitoes (pig’s trotters). Flexor tendons of pettitoes are very similar to human flexor tendons, and young surgeons can learn surgical skills with repeatable sutures. The purposes of this report are to present our training program of flexor tendon suture using pettitoes and to assess the efficacy of this program. Methods: Forty residents participated in the program and answered a questionnaire. After brief instruction, each resident was exposed to the flexor tendons of pettitoes. The flexor tendons were cut and repaired with Tsuge’s 4-strand technique using 4-0 loop nylon threads. Residents were instructed not to grip the tendons with the forceps, and suture them as atraumatic as possible. Post program evaluation was performed using the questionnaire data. Results: All participants were able to understand the theory and concept of flexor tendon suture and could complete the flexor tendon sutures in any manner under the guidance of an instructor; however, they could not accomplish sutures fully using the atraumatic techniques. They evaluated that they have gained 65% (25%-100%) of the ideal atraumatic technique in the self-assessment test. All participants rated our program as good or excellent. Conclusions: Pettitoes are readily available from butcher shops and cost only 100 yen (approximately US$1.00) in Japan. Flexor tendons of pettitoes are very similar to the human tendons, and the participants can learn the theory of suture, difficulty of the procedure, and the fun of hand surgery. Flexor tendon sutures using pettitoes can be recommended in the training program of hand surgery for young residents.
