American Council of Academic Plastic Surgeons

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Blue-Blood Infused Porcine Chest Wall Simulator Improves Resident Confidence of Internal Mammary Vessel Dissection
Kirsten A. Gunderson, BS; Weifeng Zeng, MD; Zeeda H. Nkana, BS; Sarah M. Lyon, MD; Nicholas J. Albano, MD; Michael L. Bentz, MD; Samuel O. Poore, MD
University of Wisconsin School of Medicine and Public Health, Department of Surgery, Division of Plastic Surgery, Madison, WI, USA

Background: Preparation of the internal mammary artery (IMA) is a critical step in autologous breast reconstruction, with limited opportunity for resident training intraoperatively. The blue-blood infused porcine chest wall — a cadaveric pig thorax embedded in a mannequin shell, connected to a saline perfusion system — is a novel, cost-effective () simulator of IMA dissection and anastomosis intended to improve resident comfort, safety and expertise with all steps of this procedure. The purpose of this study was to assess the effect of the use of this chest wall model on resident confidence in performing dissection and anastomosis of the IMA, as well as obtain resident and faculty perspectives on model realism and utility
Methods: Plastic Surgery residents and microsurgery faculty at the University of Wisconsin were invited to participate. One expert microsurgeon led individual training sessions and performed as the microsurgical assistant. Participants anonymously completed surveys prior to and immediately after their training session to assess their level of experience preparing the IMA in the OR, their confidence in their ability to perform these steps in humans, as well as their perception of model realism as compared to specific aspects of human anatomy and procedural steps performed in humans on a Likert scale. Participants were additionally asked their opinion on model utility and integration of the simulator into formal microsurgical training curriculum
Results: Every participant saw improvement in confidence after their training session in a minimum of one of eight key procedural steps identified. Of participants who had experience with this procedure in humans, the majority rated model anatomy and performance of key procedural steps as “very” or “extremely” realistic as compared to humans. 100% of participants believed practice with this model would improve residents’ ability to perform this operation in the OR and 100% of participants would recommend this model be incorporated into the existing microsurgical training curriculum
Conclusion: The blue-blood porcine chest wall simulator increases trainee confidence in performing key steps of internal mammary vessel dissection and anastomosis. The model is perceived as valuable to residents and faculty and will be formally integrated into our institutional microsurgical training curriculum.


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