A Cost-Effective Task Trainer for Complex Lip Laceration Repair

Facial laceration repair is a common emergency department procedure with important cosmetic implications for patients. In instances where the vermillion border is violated special attention must be paid to accurate opposition, as little as 1 mm of misalignment can result in poor cosmetic results. We sought to construct and evaluate an affordable, effective, and easily reproduced simulation trainer of full-thickness lip laceration requiring vermillion border repair primarily for Emergency Medicine resident education. To accomplish this we utilized microfoam tape, 4x4 gauze, self-adherent wrap, and markers to simulate a multi-layered lip laceration with vermillion border involvement. The microfoam tape with gauze folded on top of itself simulates the orbicularis oris muscle and subcutaneous fat layer. The self-adherent gauze covered by an additional piece of microfoam tape simulates the dermal/epidermal junction. This training model can be attached to an upside-down emesis basin with tape and then trainees can practice appropriate repair techniques. This task trainer was then utilized in our scheduled, simulation didactic sessions with Vanderbilt University Medical Center's Emergency Medicine residents. In total, 23 PGY 1-3 EM residents participate in the session. Nineteen (83%) completed an anonymous reporting survey rating features of the didactic on a five-point Likert scale. Resident comfort level performing the procedure prior to the teaching session was fair (mean 2.53 {SD 1.04}) and afterward significantly higher (mean 4.31 {SD 0.57}) P <0.0001. The task trainer was highly rated (mean 4.74 {SD 0.55}) and the overall didactic was also very highly rated (mean 4.84 {SD 0.50}). The model we have described here can be constructed in minutes from supplies that are readily available in any healthcare setting and was rated by residents to substantially improve procedural confidence in regards to complex lip laceration repair.