Simulation of plastic surgery and microvascular procedures using perfused fresh human cadavers

• Published in: Journal of plastic, reconstructive & aesthetic surgery Vol. 67; no. 2; pp. e42 - e48
• Main Authors: Carey, Joseph N, Rommer, Elizabeth, Sheckter, Clifford, Minneti, Michael, Talving, Peep, Wong, Alex K, Garner, Warren, Urata, Mark M
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.02.2014
• Subjects: Angiography; Cadaver; Coloring Agents; Education, Medical, Graduate - methods; Fresh tissue dissection; Humans; Indocyanine Green; Microsurgery; Microsurgery - education; Microvessels - surgery; Plastic Surgery; Reconstructive Surgical Procedures - education; Resident education; Resident work hour restrictions; Surgery, Plastic - education; Surgical education; Surgical Flaps; Surgical simulation; Vascular Surgical Procedures - education; Resident education; Microsurgery; Resident work hour restrictions; Fresh tissue dissection; Surgical simulation; Surgical education
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2013.09.026

Summary Introduction 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. Method 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. Result 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. Conclusion 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.