Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, Agaplesion Markus Hospital, Frankfurt, Germany; Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center, Eberhard Karls University Tuebingen, Tuebingen, Germany.
Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center, Eberhard Karls University Tuebingen, Tuebingen, Germany; Department of Hand, Plastic and Aesthetic Surgery, Medius Hospital Nuertingen, Nuertingen, Germany.
J Surg Res. 2021 Jun;262:190-196. doi: 10.1016/j.jss.2021.01.011. Epub 2021 Feb 16.
The safe execution of local flaps tends to be challenging for surgical residents. Thus, the purpose of the study was to evaluate a training model of local flaps based on fresh human skin excised from body contouring procedures.
A questionnaire and surgical skills evaluation-analyzing the theoretical and procedural knowledge about local flaps-were held both before and after the surgical skills training. All surgical procedures were executed on a simulation model based on fresh human skin. Skills evaluation was done according to a modified version of the Objective Structured Assessment of Technical Skills Score. Results before and after the training were compared using SPSS, version 21.
In pretraining evaluation, residents showed great difficulty regarding the accuracy of flap design and sufficiency of wound coverage indicating the need for surgical training outside the operating theater. After training, the procedural skills significantly improved as depicted by the modified Objective Structured Assessment of Technical Skills score with a mean cumulative pretraining score of 26.81 ± 5.41 and posttraining score of 43.59 ± 5.72 (P = 0.008). Also, theoretical knowledge significantly improved in the posttraining evaluation with exception to the indication of a Z-plasty (P = 0.257). The training model itself was generally regarded as highly useful and thus recommendable to others.
Surgical handling and the understanding of tissue rotation clearly improved by the presented model which mimics very realistic conditions. The simulation model based on fresh human skin shows cost-effectiveness and allows a broad range for flap procedures wherefore its use should be further promoted.
对于外科住院医师来说，安全实施局部皮瓣往往具有挑战性。因此，本研究旨在评估一种基于从身体整形手术中切除的新鲜人体皮肤的局部皮瓣培训模型。
在手术技能培训前后，通过问卷调查和手术技能评估（分析关于局部皮瓣的理论和程序知识），分别对其进行评估。所有手术均在基于新鲜人体皮肤的模拟模型上进行。技能评估根据客观结构化手术技能评估评分的修改版进行。使用 SPSS 版本 21 比较培训前后的结果。
在培训前评估中，住院医师在皮瓣设计的准确性和伤口覆盖的充分性方面存在很大困难，这表明需要在手术室之外进行手术培训。培训后，程序技能显著提高，改良的客观结构化手术技能评估评分显示，平均累积术前评分为 26.81±5.41，术后评分为 43.59±5.72（P=0.008）。此外，术后评估中的理论知识也显著提高，但除了 Z 成形术的适应证外（P=0.257）。培训模型本身被普遍认为非常有用，因此值得向他人推荐。
本模型模拟了非常真实的情况，明显提高了手术操作和对组织旋转的理解。基于新鲜人体皮肤的模拟模型具有成本效益，可以广泛应用于皮瓣手术，因此应进一步推广其使用。
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