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Pork Belly: A Simulation Training Model for Intramuscular Perforator Dissection.

Georgios Pafitanis1, Damjan Veljanoski1, Ali M Ghanem1

  • 1The 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.

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A novel pork belly simulation effectively trains surgeons in deep inferior epigastric artery perforator (DIEAP) flap dissection. This inexpensive, ethical model provides a high-fidelity simulation for essential intramuscular dissection skills.

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Area of Science:

  • Microsurgery training
  • Surgical simulation
  • Anatomical dissection

Background:

  • Free tissue transfer techniques have advanced from muscle to fasciocutaneous flaps.
  • Dissecting intramuscular vessels for flaps presents significant technical challenges.
  • Current nonliving simulation models for microsurgery are evolving, but living models like porcine or cadavers are costly for initial training.

Purpose of the Study:

  • To validate an affordable ex vivo porcine model for simulating the harvest of the deep inferior epigastric artery perforator (DIEAP) flap.
  • To specifically incorporate and assess perforator intramuscular dissection within the simulation model.

Main Methods:

  • An initial needs analysis and anatomical dissections defined the model's design.
  • A pilot study used objective measures (time, hand motion analysis) to assess surgeon performance.
  • Participant feedback was gathered via a detailed questionnaire to evaluate the model's perceived utility.

Main Results:

  • Vascular anatomy of inferior epigastric vessels was detailed from 15 dissected pork bellies.
  • Eight surgeons successfully performed the flap design, demonstrating construct validity in flap raising and intramuscular dissection.
  • All participants recommended the ex vivo model as a foundational step for intramuscular dissection training.

Conclusions:

  • The pork belly simulation offers a cost-effective, accessible, and ethically sound method for practicing intramuscular dissection for DIEAP free flaps.
  • Further research is needed to determine if the lack of physiological blood flow impacts skills acquisition.
  • This model serves as an ideal initial step before progressing to more complex in vivo porcine models.