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Teaching Small Bite Fascial Closure Technique: Improved Accuracy and Consistency Through Simulation.

Natalie Cuevas1, Seth T Beeson2, Justin D Faulkner3

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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.

Keywords:
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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.