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Simulating the IMA Recipient Site for DIEP Flap Surgery: A New Model for Dynamic Microsurgery Simulation with
Natalia I Ziolkowski1, Kimberly Z Sun2, Catherine McMillan3
1Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Journal of Reconstructive Microsurgery
|April 27, 2022
Summary
A new simulation model accurately replicates the depth and respiratory motion of internal mammary vessels for breast reconstruction (BR) surgery. This innovative tool enhances microsurgical education by providing realistic training for plastic and reconstructive surgery trainees.
Area of Science:
- Microsurgery
- Surgical Simulation
- Breast Reconstruction
Background:
- Autologous free flap breast reconstruction (BR) offers significant psychosocial and quality-of-life benefits.
- Microsurgical procedures present a steep learning curve due to operative challenges.
- Existing simulation models lack realistic respiratory excursion and internal mammary vessel depth representation.
Purpose of the Study:
- To measure intraoperative depth and motion of internal mammary vessels during BR.
- To develop a dynamic simulation model based on these measurements.
- To evaluate the simulator's effectiveness as an educational tool for trainees.
Main Methods:
- Single-center study involving patients undergoing free flap BR.
- Intraoperative measurements of vessel depth and respiratory excursion were recorded.
- A dynamic simulation model was created; trainees practiced anastomosis on the simulator and completed pre/post-questionnaires.
Main Results:
- Analyzed 15 operative sites; vessel depth was 4-5 cm with 3.7±1.0 mm excursion at 9-14 breaths/min.
- No correlation found between patient factors (radiation, BMI, vitals) and vessel depth/movement.
- Pilot study with 22 trainees showed increased confidence and varied anxiety levels post-simulation.
Conclusions:
- A novel microsurgical simulation model for deep inferior epigastric perforator free flap BR was developed.
- The model realistically replicates in situ vessel movement with respiratory excursion.
- This simulation tool shows promise for enhancing microsurgical education and training.
