Development of a porcine training model for microvascular fasciocutaneous free flap reconstruction.
Free flap surgery
Microvascular flap
Oral and maxillofacial surgery
Plastic and reconstructive surgery
Porcine animal model
Surgical training model
Journal
Head & face medicine
ISSN: 1746-160X
Titre abrégé: Head Face Med
Pays: England
ID NLM: 101245792
Informations de publication
Date de publication:
03 Jun 2024
03 Jun 2024
Historique:
received:
26
01
2024
accepted:
26
05
2024
medline:
4
6
2024
pubmed:
4
6
2024
entrez:
3
6
2024
Statut:
epublish
Résumé
In reconstructive surgery, improvements are needed in the effective teaching of free flap surgery. There is a need for easily accessible and widely available training without high financial costs or ethical concerns while still providing a realistic experience. Our aim was to develop an appropriate training model for microvascular flaps. We identified pig head halves as most appropriate regarding availability, cost, and realism. These accrue largely by the food industry, so no animals need to be sacrificed, making it more ethical from an animal welfare perspective. We evaluated the suitability as flap donor site and analyzed the vascular anatomy of 51 specimens. Anatomical evaluation revealed a reliable and constant vascular anatomy, allowing the design of a flap model that can effectively illustrate the entire process of microvascular flap surgery. The process was divided into 6 key steps. The flap can be harvested after marking the vascular pedicle 5.3 cm from the lateral corner of the mouth. Skin island design and subsequent tissue dissection follow until a fasciocutaneous flap is raised, similar to a radial flap. Upon completion of flap harvesting, it can be freely transferred for defect reconstruction. Microvascular anastomosis can be performed on recipient vessels in the cervical region, and the difficulty can be individually adjusted. The developed training model is a reasonable compromise in terms of surgical realism, availability, didactic value, and cost/time effectiveness. We believe it is a powerful and effective tool with high potential for improving surgical education and training.
Sections du résumé
BACKGROUND
BACKGROUND
In reconstructive surgery, improvements are needed in the effective teaching of free flap surgery. There is a need for easily accessible and widely available training without high financial costs or ethical concerns while still providing a realistic experience. Our aim was to develop an appropriate training model for microvascular flaps.
METHODS
METHODS
We identified pig head halves as most appropriate regarding availability, cost, and realism. These accrue largely by the food industry, so no animals need to be sacrificed, making it more ethical from an animal welfare perspective. We evaluated the suitability as flap donor site and analyzed the vascular anatomy of 51 specimens.
RESULTS
RESULTS
Anatomical evaluation revealed a reliable and constant vascular anatomy, allowing the design of a flap model that can effectively illustrate the entire process of microvascular flap surgery. The process was divided into 6 key steps. The flap can be harvested after marking the vascular pedicle 5.3 cm from the lateral corner of the mouth. Skin island design and subsequent tissue dissection follow until a fasciocutaneous flap is raised, similar to a radial flap. Upon completion of flap harvesting, it can be freely transferred for defect reconstruction. Microvascular anastomosis can be performed on recipient vessels in the cervical region, and the difficulty can be individually adjusted.
CONCLUSIONS
CONCLUSIONS
The developed training model is a reasonable compromise in terms of surgical realism, availability, didactic value, and cost/time effectiveness. We believe it is a powerful and effective tool with high potential for improving surgical education and training.
Identifiants
pubmed: 38831370
doi: 10.1186/s13005-024-00435-z
pii: 10.1186/s13005-024-00435-z
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
35Informations de copyright
© 2024. The Author(s).
Références
Yang GF, Chen PJ, Gao YZ, Liu XY, Li J, Jiang SX, He SP. Forearm free skin flap transplantation. Natl Med J China. 1981;149(2):139–42.
Wolff KD, Hölzle F. Raising of Microvascular Flaps: A Systematic Approach, 2nd Edition edn. Berlin: Springer; 2011.
Nobis CP, Bauer F, Rohleder NH, Wolff KD, Kesting MR. Development of a haptic model for teaching in reconstructive surgery–the radial forearm flap. Simul Healthcare: J Soc Simul Healthc. 2014;9(3):203–8.
doi: 10.1097/SIH.0000000000000000
Bodin F, Diana M, Koutsomanis A, Robert E, Marescaux J, Bruant-Rodier C. Porcine model for free-flap breast reconstruction training. J Plast Reconstr Aesthetic Surgery: JPRAS. 2015;68(10):1402–9.
doi: 10.1016/j.bjps.2015.06.006
pubmed: 26184772
Avram TE, Muntean M, Janko B, Ardelean F, Pestean C, Lacatus R, Matei IR, Georgescu AV. Free-flap breast reconstruction on experimental porcine model. Injury. 2019;50(Suppl 5):S123–5.
doi: 10.1016/j.injury.2019.10.062
pubmed: 31706588
Gonzalez-Garcia JA, Chiesa-Estomba CM, Alvarez L, Altuna X, Garcia-Iza L, Thomas I, Sistiaga JA, Larruscain E. Porcine experimental model for perforator flap raising in reconstructive microsurgery. J Surg Res. 2018;227:81–7.
doi: 10.1016/j.jss.2018.02.025
pubmed: 29804867
Bauer F, Koerdt S, Holzle F, Mitchell DA, Wolff KD. Eight free flaps in 24 hours: a training concept for postgraduate teaching of how to raise microvascular free flaps. Br J Oral Maxillofac Surg. 2016;54(1):35–9.
doi: 10.1016/j.bjoms.2015.10.033
pubmed: 26628198
Tellioglu AT, Eker E, Cimen K, Comert A, Karaeminogullari G, Tekdemir I. Training model for microvascular anastomosis. J Craniofac Surg. 2009;20(1):238–9.
doi: 10.1097/SCS.0b013e3181843ade
pubmed: 19165035
Sidwell RA. Intraoperative Teaching and evaluation in general surgery. Surg Clin North Am. 2021;101(4):587–95.
doi: 10.1016/j.suc.2021.05.006
pubmed: 34242602
Vinden C, Malthaner R, McGee J, McClure JA, Winick-Ng J, Liu K, Nash DM, Welk B, Dubois L. Teaching surgery takes time: the impact of surgical education on time in the operating room. Can J Surg. 2016;59(2):87–92.
doi: 10.1503/cjs.017515
pubmed: 27007088
pmcid: 4814276
Gallo G, Guaitoli E, Barra F, Picciariello A, Pasculli A, Coppola A, Pertile D, Meniconi RL, Group SSTW. Restructuring surgical training after COVID-19 pandemic: a nationwide survey on the Italian scenario on behalf of the Italian polyspecialistic young surgeons society (SPIGC). Front Surg. 2022;9:1115653.
doi: 10.3389/fsurg.2022.1115653
pubmed: 36713665
Ruiz-Gomez JL, Martin-Parra JI, Gonzalez-Noriega M, Redondo-Figuero CG, Manuel-Palazuelos JC. Simulation as a surgical teaching model. Cir Esp (Engl Ed). 2018;96(1):12–7.
pubmed: 29054573
Atesok K, Satava RM, Marsh JL, Hurwitz SR. Measuring Surgical skills in Simulation-based training. J Am Acad Orthop Surg. 2017;25(10):665–72.
doi: 10.5435/JAAOS-D-16-00253
pubmed: 28953081
Villanueva C, Xiong J, Rajput S. Simulation-based surgical education in cardiothoracic training. ANZ J Surg. 2020;90(6):978–83.
doi: 10.1111/ans.15593
pubmed: 31828909
Wang EE, Vozenilek JA, Flaherty J, Kharasch M, Aitchison P, Berg A. An innovative and inexpensive model for teaching cricothyrotomy. Simul Healthcare: J Soc Simul Healthc. 2007;2(1):25–9.
doi: 10.1097/SIH.0b013e3180302124
Govila A. A simple model on which to practise microsurgical technique: a fresh chicken. Br J Plast Surg. 1981;34(4):486–7.
doi: 10.1016/0007-1226(81)90065-5
pubmed: 7296158
Jeong HS, Moon MS, Kim HS, Lee HK, Yi SY. Microsurgical training with fresh chicken legs. Ann Plast Surg. 2013;70(1):57–61.
doi: 10.1097/SAP.0b013e31822f9931
pubmed: 22156886
Sucur D, Konstantinovic P, Potparic Z. Fresh chicken leg: an experimental model for the microsurgical beginner. Br J Plast Surg. 1981;34(4):488–9.
doi: 10.1016/0007-1226(81)90066-7
pubmed: 7296159
Loh CYY, Wang AYL, Tiong VTY, Athanassopoulos T, Loh M, Lim P, Kao HK. Animal models in plastic and reconstructive surgery simulation-a review. J Surg Res. 2018;221:232–45.
doi: 10.1016/j.jss.2017.08.052
pubmed: 29229134
Bartline PB, O’Shea J, McGreevy JM, Mueller MT. A novel perfused porcine simulator for teaching aortic anastomosis increases resident interest in vascular surgery. J Vasc Surg. 2017;66(2):642–e648644.
doi: 10.1016/j.jvs.2017.01.049
pubmed: 28506475
Rodriguez A, Alvarez A, Aguirrezabalaga J, Martelo F. The anteromedial thigh flap as a training model of a perforator flap in rat. J Reconstr Microsurg. 2007;23(5):251–5.
doi: 10.1055/s-2007-985204
pubmed: 17876727
Miyamoto S, Takushima A, Okazaki M, Shiraishi T, Minabe T, Harii K. Free pectoral skin flap in the rat based on the long thoracic vessels: a new flap model for experimental study and microsurgical training. Ann Plast Surg. 2008;61(2):209–14.
doi: 10.1097/SAP.0b013e318157a6ea
pubmed: 18650617
Allen RJ Jr., Chen CM, Warren SM. Free pectoral skin flap in the rat based on the long thoracic vessels: a new flap model for experimental study and microsurgical training. Ann Plast Surg. 2008;61(4):479–80.
doi: 10.1097/SAP.0b013e318162b058
pubmed: 18812725
Nutt J, Mehdian R, Parkin I, Dent J, Kellett C. Cadaveric surgery: a novel approach to teaching clinical anatomy. Clin Teach. 2012;9(3):148–51.
doi: 10.1111/j.1743-498X.2012.00536.x
pubmed: 22587312
Kersey TL. Split pig head as a teaching model for basic oculoplastic procedures. Ophthalmic Plast Reconstr Surg. 2009;25(3):253.
doi: 10.1097/IOP.0b013e3181a394c1
pubmed: 19454952
Kuwahara RT, Rasberry R. Pig head model for practice cutaneous surgery. Dermatologic surgery: official publication for American Society for dermatologic surgery 2000, 26(4):401–2.
Fichter AM, Ritschl LM, Borgmann A, Humbs M, Luppa PB, Wolff KD, Mucke T. Development of an extracorporeal perfusion device for Small Animal Free flaps. PLoS ONE. 2016;11(1):e0147755.
doi: 10.1371/journal.pone.0147755
pubmed: 26808996
pmcid: 4726627
Nam SM, Shin HS, Kim YB, Park ES, Choi CY. Microsurgical training with porcine thigh infusion model. J Reconstr Microsurg. 2013;29(5):303–6.
doi: 10.1055/s-0033-1333623
pubmed: 23393048