Teaching Small Bite Fascial Closure Technique: Improved Accuracy and Consistency Through Simulation
Natalie Cuevas1, Seth T Beeson2, Justin D Faulkner3
1UNC School of Medicine, Chapel Hill, NC, USA.
The American Surgeon
|March 20, 2023
Summary
Surgeons using small bites for fascial closure improves accuracy and consistency. A templated model further enhances this technique, leading to better surgical outcomes and potentially reducing hernia rates.
Area of Science:
- Surgical technique
- Medical education
- Biomedical engineering
Background:
- Small bite closure in fascial repair is evidence-based but surgeon technique consistency is poorly documented.
- Accurate and consistent fascial closure is crucial for preventing complications like incisional hernias.
Purpose of the Study:
- To evaluate the accuracy and consistency of surgical residents' fascial bite sizes.
- To assess the impact of a templated model on improving fascial closure technique.
Main Methods:
- A felt model simulating fascial closure was used with 14 surgical residents.
- Residents performed closures using 1 cm and 5 mm bite sizes, both with and without a template guide.
- Bite accuracy (distance from midline) and consistency (travel variation) were measured.
Main Results:
- Taking 5 mm bites required more time but improved accuracy and consistency.
- The use of a template significantly reduced variation in bite travel and distance from the midline.
- Template use improved consistency regardless of the intended bite size.
Conclusions:
- The principle 'aim small, miss small' applies to fascial closure, with smaller bites enhancing closure quality.
- A templated model is an effective educational tool to improve surgical residents' accuracy and consistency in fascial closure.
- Improved fascial closure technique may contribute to reduced hernia rates.
