Pafitanis Georgios, Veljanoski Damjan, Ghanem Ali M, Myers Simon
The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom; Academic Plastic Surgery Group, The Blizard Institute, Queen Mary University of London, London, United Kingdom; Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, United Kingdom; The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom; and The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom.
Plast Reconstr Surg Glob Open. 2018 Feb 14;6(2):e1674. doi: 10.1097/GOX.0000000000001674. eCollection 2018 Feb.
Free tissue transfer has evolved from muscle flaps to fasciocutaneous flaps. Dissection of the intramuscular course of feeding vessels is technically challenging. Simulation-based microsurgery skills acquisition is moving toward nonliving training models. Living porcine model or human cadavers are currently cost-ineffective methods for the early learning curve in teaching intramuscular dissection. The aim of this study was to validate an inexpensive ex vivo porcine model simulating harvest of the deep inferior epigastric artery perforator (DIEAP) flap, specifically including perforator intramuscular dissection.
An initial needs analysis and anatomical dissections (characteristics of vascular anatomy) established the necessity and surgical design (step-by-step) of the ex vivo DIEAP flap harvesting model. A pilot study utilizing objective assessment methodology (time to complete flap raising and hand motion analysis) demonstrated the surgeons' performance. A detailed feedback questionnaire was used to assess the participants' perception of this model.
Fifty-seven participants completed the initial needs analysis. Fifteen pork bellies were dissected and the vascular anatomical characteristics of the inferior epigastric vessels are presented. Eight surgeons performed the step-by-step flap design demonstrating construct validity in flap raising and intramuscular dissection. All surgeons completed the ex vivo DIEAP harvesting and they recommend this model as the first step in training for intramuscular dissection.
The pork belly simulation is a cheap, easy, ethically considerate, and high-fidelity simulation model for intramuscular dissection for the DIEAP free flap. This study guides future validation trials to explore if the absence of physiological blood flow affects skills acquisition in the intramuscular dissection learning curve. The pork belly could be the first step in perforators dissection before progressing to the in vivo porcine model.
游离组织移植已从肌皮瓣发展到筋膜皮瓣。解剖供养血管的肌内走行在技术上具有挑战性。基于模拟的显微外科技能获取正朝着非活体训练模型发展。目前，在教授肌内解剖的早期学习阶段，使用活体猪模型或人体尸体成本效益不高。本研究的目的是验证一种廉价的离体猪模型，该模型模拟腹壁下动脉穿支（DIEAP）皮瓣的切取，特别包括穿支肌内解剖。
初步需求分析和解剖学研究（血管解剖特征）确定了离体DIEAP皮瓣切取模型的必要性和手术设计（分步进行）。一项利用客观评估方法（完成皮瓣掀起的时间和手部动作分析）的初步研究展示了外科医生的操作表现。使用详细的反馈问卷来评估参与者对该模型的看法。
57名参与者完成了初步需求分析。解剖了15块猪肚，并展示了腹壁下血管的血管解剖特征。8名外科医生进行了分步皮瓣设计，证明在皮瓣掀起和肌内解剖方面具有结构效度。所有外科医生都完成了离体DIEAP切取，他们推荐该模型作为肌内解剖训练的第一步。
猪肚模拟是一种用于DIEAP游离皮瓣肌内解剖的廉价、简便、符合伦理且高保真的模拟模型。本研究指导未来的验证试验，以探索缺乏生理性血流是否会影响肌内解剖学习曲线中的技能获取。在进展到活体猪模型之前，猪肚可以作为穿支解剖的第一步。
