Division of Plastic & Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
Division of Plastic & Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
J Plast Reconstr Aesthet Surg. 2014 Feb;67(2):e42-8. doi: 10.1016/j.bjps.2013.09.026. Epub 2013 Sep 23.
Surgical simulation models are often limited by their lack of fidelity, which hinders their essential purpose, making a better surgeon. Fresh cadaveric tissue is a superior model of simulation owing to its approximation of live tissue. One major unresolved difference between dead and live tissue is perfusion. Here, we propose a means of enhancing the fidelity of cadaveric simulation through the development of a perfused cadaveric model whereby simulation is further able to approach life-like surgery and teach one of the more technically demanding skills of plastic surgery: microsurgery.
Fresh tissue human cadavers were procured according to university protocol. Perfusion was performed via cannulation of large vessels, and arterial and venous pressure was maintained by centrifugal circulation. Skin perfusion was evaluated with incisions in the perfused regions and was evaluated using indocyanine green angiography. Surgical simulations were selected to broadly evaluate applicability to plastic surgical education.
Surgical simulation of 38 procedures ranging in complexity from skin excisions to microsurgical cases was performed with high priority given to the accurate simulation of clinical procedures. Flap dissections included perforator flaps, muscle flaps, and fasciocutaneous flaps. Effective perfusion was noted with ICG angiography and notable bleeding vessels. Microsurgical flap transfer was successfully performed.
We report the establishment of a high fidelity surgical simulation using a perfused fresh tissue model in a realistic environment akin to the operating room. We anticipate utilization of this model prior to entering the operating room will enhance surgical ability and offer a valuable resource in plastic surgical education.
手术模拟模型通常受到保真度的限制，这阻碍了它们成为更好的外科医生的基本目的。由于其接近活体组织，新鲜的尸体组织是模拟的优越模型。死组织和活组织之间的一个主要未解决的区别是灌注。在这里，我们提出了一种通过开发灌注尸体模型来提高尸体模拟保真度的方法，从而使模拟更接近逼真的手术，并教授整形外科中更具技术挑战性的技能之一：显微外科。
根据大学协议采购新鲜组织人体尸体。通过大血管插管进行灌注，并通过离心循环维持动脉和静脉压。通过在灌注区域的切口评估皮肤灌注，并通过吲哚菁绿血管造影评估。选择手术模拟来广泛评估其在整形外科学教育中的适用性。
进行了 38 种手术模拟，从皮肤切除到显微手术病例，复杂程度不一，高度重视准确模拟临床手术。皮瓣解剖包括穿支皮瓣、肌肉皮瓣和筋膜皮瓣。ICG 血管造影和明显的出血血管显示出有效的灌注。成功进行了显微皮瓣转移。
我们报告了在手术室类似的真实环境中使用灌注新鲜组织模型进行高保真手术模拟的建立。我们预计在进入手术室之前使用这种模型将提高手术能力，并为整形外科学教育提供有价值的资源。
