Basic Plastic Surgery Skills Training Program on Inanimate Bench Models during Medical Graduation

Abstract

Due to ethical and medical-legal drawbacks, high costs, and difficulties of accessibility that are inherent to the practice of basic surgical skills on living patients, fresh human cadaver, and live animals, the search for alternative forms of training is needed. In this study, the teaching and learning process of basic surgical skills pertinent to plastic surgery during medical education on different inanimate bench models as a form of alternative and complementary training to the teaching programs already established is proposed.

Figure 1

Learning goals. Undergraduates should initially perform basic surgical knowledge and then be trained on the most complex surgical skills.

Figure 2

Inanimate bench models simulating incision and suture techniques. (a, b) Cattle-skin bench model simulating circular, linear and elliptic patterns of incision. (c) Pig-skin bench model simulating vertical mattress suture. (d) Synthetic ethylene-vinyl acetate bench model simulating subdermal interrupted suture; training should preferably be carried out near the edges of the material, and it is advisable to use multiple overlapping synthetic material plates aiming to mimic the different layers of the skin. Note that all the three bench models are simulating the procedures in a three-dimensional way.

Figure 3

Inanimate bench models simulating elliptical biopsy technique. (a, b, and c) Synthetic ethylene-vinyl acetate bench model and (d, e, and f) chicken-skin bench model simulating (a, d) the safety margins forming an ellipse, (b, e) the intact removal of the “surgical piece", and repair of the surgical defects with the confection of (c) intradermal suture and (f) running simple suture. Note that both bench models allow three-dimensional understanding of the whole process of training.

Figure 5

Inanimate bench models simulating flaps. (a, b, and c) Ox tongue bench model simulating a monopedicle advancement flap. (d, e, and f) Chicken-skin bench model simulating a Z-plasty. Note that students can easily see the advancement and transposition of surgical flaps, which often is hard to understand with the use of two-dimensional models. For example, it is simpler to explain that the center line of the Z-plasty should be placed along the scar, since it is this component that will be lengthened.

Figure 4

Chicken-skin bench model simulating a subcutaneous lipoma. (a) A small styrofoam ball should be placed in a subcutaneous tunnel made in the posterior portion of the model with the intention of (b) mimicking the cutaneous lesion. Following, students must (c) incise the skin, (d) carefully dissect the lesion, (e) resect it completely, and (f) repair the defect by means of single interrupted sutures.

Figure 6

Organic bench model simulating (a) a necrotic wound and its (b) careful surgical debridement.

Figure 7

Cattle-skin bench model simulating (a) a nonmelanoma skin cancer with safety margins, (b) complete surgical excision of the “cutaneous tumor,” (c) repair of the defect by placing an ox tongue graft, and (d) a pressure dressing fixed with braided suture over the gauze wad.