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尸体回归:解剖在整形外科住院医师培训中的关键作用。

Return of the cadaver: Key role of anatomic dissection for plastic surgery resident training.

作者信息

Krähenbühl Swenn Maxence, Čvančara Paul, Stieglitz Thomas, Bonvin Raphaël, Michetti Murielle, Flahaut Marjorie, Durand Sébastien, Deghayli Lina, Applegate Lee Ann, Raffoul Wassim

机构信息

Plastic, Reconstructive and Hand Surgery Division, CHUV - Lausanne University Hospital, Lausanne, Switzerland Laboratory for Biomedical Microtechnology, University of Freiburg, Freiburg im Breisgau, Germany Education Unit, CHUV - Lausanne University Hospital, Lausanne, Switzerland.

出版信息

Medicine (Baltimore). 2017 Jul;96(29):e7528. doi: 10.1097/MD.0000000000007528.

Abstract

Successful Plastic Surgery Residency training is subjected to evolving society pressure of lower hourly work weeks imposed by external committees, labor laws, and increased public awareness of patient care quality. Although innovative measures for simulation training of surgery are appearing, there is also the realization that basic anatomy training should be re-enforced and cadaver dissection is of utmost importance for surgical techniques.In the development of new technology for implantable neurostimulatory electrodes for the management of phantom limb pain in amputee patients, a design of a cadaveric model has been developed with detailed steps for innovative transfascicular insertion of electrodes. Overall design for electrode and cable implantation transcutaneous was established and an operating protocol devised.Microsurgery of the nerves of the upper extremities for interfascicular electrode implantation is described for the first time. Design of electrode implantation in cadaver specimens was adapted with a trocar delivery of cables and electrodes transcutaneous and stabilization of the electrode by suturing along the nerve. In addition, the overall operating arena environment with specific positions of the multidisciplinary team necessary for implantable electrodes was elaborated to assure optimal operating conditions and procedures during the organization of a first-in-man implantation study.Overall importance of plastic surgery training for new and highly technical procedures is of importance and particularly there is a real need to continue actual cadaveric training due to patient variability for nerve anatomic structures.

摘要

成功的整形外科住院医师培训面临着不断变化的社会压力,这些压力来自外部委员会规定的更低每周工作时长、劳动法以及公众对患者护理质量意识的提高。尽管出现了手术模拟训练的创新措施,但人们也认识到应加强基础解剖学训练,尸体解剖对于手术技术至关重要。在开发用于治疗截肢患者幻肢痛的植入式神经刺激电极新技术过程中,已开发出一种尸体模型设计,并详细介绍了电极创新经束插入的步骤。确立了电极和电缆经皮植入的总体设计,并制定了操作方案。首次描述了用于上肢神经束间电极植入的显微外科手术。尸体标本中的电极植入设计采用了经皮套管输送电缆和电极,并通过沿神经缝合来固定电极。此外,还详细说明了植入式电极所需多学科团队特定位置的整体手术环境,以确保在开展首例人体植入研究时具备最佳手术条件和程序。整形外科培训对于新的高技术手术程序至关重要,特别是由于神经解剖结构的个体差异,确实有必要继续进行实际的尸体训练。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c0aa/5521907/bdd835158ad6/medi-96-e7528-g001.jpg

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