A Training Model for Local Flaps Using Fresh Human Skin Excised During Body Contouring Procedures

Merits of simulation-based education: A systematic review and meta-analysis

BACKGROUND

The drive to improve surgical proficiency through advanced simulation-based training has gained momentum. This meta-analysis systematically evaluated evidence regarding the impact of plastic surgery-related simulation on the performance of residents.

METHODS

A systematic search of PubMed, Web of Science, and Cochrane Library and review of articles was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol. An inverse-variance random-effects model was used to combine study estimates to account for between-study variability. Objective structured assessment of technical skills (OSATS) scores and subjective confidence scores were used to assess the impact of the simulation with positive changes from the baseline indicating better outcomes.

RESULTS

Eighteen studies pooling 367 trainees who participated in various simulations were included. Completion of simulation training was associated with significant improvement in subjective confidence scores with a mean increase of 1.44 units (95% CI: 0.93 to 1.94, P < 0.001), and in OSATS scores, with a mean increase of 1.24 units (95% CI: 0.87 to 1.62, P < 0.001), both on a 1-5 scale. Participants reported high satisfaction scores (mean = 4.76 units, 95% CI = 4.61 to 4.91, P = 0.006), also on a 1-5 scale.

CONCLUSIONS

Participation in surgical simulation markedly improved objective and subjective scoring metrics for surgical trainees. Several simulation devices are available for honing surgical skills, with the potential for advancements. The evidence demonstrates the effectiveness of simulations; thus, incorporating simulation into training curricula should be a priority in the field of plastic surgery.

Advancing Surgical Education: A Comprehensive Systematic Review with Meta-Analysis and Novel Approach to Training Models for Local Skin Advancement Flaps

Performing local skin flaps is a challenging task that requires cognitive and technical skills to design flaps with proper orientation to avoid distorting normal anatomy. Junior trainees need adequate exposure to gain confidence and expertise in such procedures. This article systematically reviews the literature's different local skin advancement flap training models and describes a new, easy-to-use training model. A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Cochrane, Web of Science, and Google Scholar databases were searched from their inception until August 2022 for articles about local skin advancement flap training models. The meta-analysis results were pooled across the studies using a random-effects model and presented as a weighted mean difference with a 95% confidence interval (95% CI). Out of 773 reviewed articles, 18 were included in the systematic review, and four reported enough data to be included in the meta-analysis. Rhomboid and Z-plasty flaps were the most commonly taught flaps by training models. The most commonly used training models were synthetic-based, followed by animal-based models. The training models significantly increased the trainees' confidence and expertise regarding local skin flap procedures (p<0.00001) for both domains. Training models, per our reported data, significantly improve the trainees' confidence and expertise in performing local skin advancement flap procedures; continuous efforts in developing and establishing new, simple-to-use, and effective training models are strongly encouraged to further improvement of surgical education and enhance the trainees' surgical skills.

Simulation models for learning local skin flap design and execution: A systematic review of the literature

Introduction

Early exposure to practical skills in surgical training is essential in order to master technically demanding procedures such as the design and execution of local skin flaps. Changes in working patterns, increasing subspecializations, centralization of surgical services, and the publication of surgeon-specific outcomes have all made hands-on-training in a clinical environment increasingly difficult to achieve for the junior surgeon. This has been further compounded by the COVID-19 pandemic. This necessitates alternative methods of surgical skills training. To date, there are no standardized or ideal simulation models for local skin flap teaching.

Aim

This systematic review aims to summarize and evaluate local skin flap simulation and teaching models published in the literature.

Materials and Methods

A systematic review protocol was developed and undertaken in accordance with PRISMA guidelines. Key search terms encompassed both “local skin flaps” and “models” or “surgical simulation”. These were combined using Boolean logic and used to search Embase, Medline, and the Cochrane Library. Studies were collected and screened according to the inclusion criteria. The final included articles were graded for their level of evidence and recommendation based on a modified educational Oxford Center for evidence-based medicine classification system and assessed according to the CRe-DEPTH tool for articles describing training interventions in healthcare professionals.

Results

A total of 549 articles were identified, resulting in the inclusion of 16 full-text papers. Four articles used 3D simulators for local flap teaching and training, while two articles described computer simulation as an alternative method for local flap practicing. Four models were silicone based, while gelatin, Allevyn dressings, foam rubber, and ethylene-vinyl acetate-based local flap simulators were also described. Animal models such as pigs head, porcine skin, chicken leg, and rat, as well as a training model based on fresh human skin excised from body-contouring procedures, were described. Each simulation and teaching method was assessed by a group of candidates via a questionnaire or evaluation survey grading system. Most of the studies were graded as level of evidence 3 or 4.

Conclusion

Many methods of simulation for the design and execution of local skin flaps have been described. However, most of these have been assessed only in small cohort numbers, and, therefore, larger candidate sizes and a standardized method for assessment are required. Moreover, some proposed simulators, although promising, are in a very preliminary stage of development. Further development and evaluation of promising high-fidelity models is required in order to improve training in such a complex area of surgery.

Simulation in plastic and reconstructive surgery: a scoping review

Since the origins of surgery, simulation has played an important role in surgical education, particularly in plastic and reconstructive surgery. This has greater relevance in contemporary settings of reduced clinical exposure resulting in limited work-based learning opportunities. With changing surgical curricula, it is prescient to examine the role of simulation in plastic and reconstructive surgery.

A scoping review protocol was used to identify relevant studies, with an iterative process identifying, reviewing and charting the data to derive reported outcomes and themes.

Of the 554 studies identified, 52 studies were included in this review. The themes identified included simulator modalities, curriculum elements targeted and relevant surgical competencies. There was a predominance of synthetically based simulators, targeting technical skills largely associated with microsurgery, paediatric surgery and craniomaxillofacial surgery.

Existing simulators largely address high-complexity procedures. There are multiple under-represented areas, including low-complexity procedures and simulation activities addressing communication, collaboration, management and leadership. There are many opportunities for simulation in surgical education, which requires a contextual appreciation of educational theory. Simulation may be used both as a learning method and as an assessment tool.

This review describes the literature relating to simulation in plastic and reconstructive surgery and proposes opportunities for incorporating simulation in a broader sense, in the surgical curriculum.