Abstract
Dear Editor,
The long journey of a new plastic surgery resident to become a fully competent plastic surgeon starts with the practice to gain basic surgical skills. The presence of various suture methods and numerous local flap designs with varying degrees of difficulty separate the field of plastic surgery from other surgical specialties, necessitating a far greater command over the skin. These skills are mostly gained through a trial-and-error method on real patients under a senior’s guidance or on some poor skin alternatives such as clothes, sponges, animal flesh, and so on. Human cadavers are costly and are not easy to access for these purposes. The utilization of resected skin material for Z-plasty practice as described by Gürünlüoğlu et al 1 seems to be a promising approach, which can be expanded to virtually all local flap designs in plastic surgery and other basic surgical applications on skin.
A generous source of skin and subcutaneous tissue resection seems to be the practice of bariatric surgery, which in recent years has significantly increased its popularity among the general population. As a direct consequence of this fact, the demand for plastic surgeons to perform body sculpturing procedures such as brachioplasty, abdominoplasty, mastopexy, and thigh lift has also become greater. 2 Thus, considerable amounts of unwanted skin resection take place.
Prior to post–bariatric surgery, an informed consent is obtained from each participating patient and the resected tissue specimens are preserved inside a gauze embedded in saline solution in special chambers between +4°C and −4°C for 7 days. Longer waiting time was found to be unrewarding, mainly because of the deteriorated tissue integrity and loss of tissue handling properties of the preserved material. Immediately following the resection procedure and during the mentioned time interval, plastic surgery residents are welcomed to practice on these skin material different surgical skills and local flap designs, including separated, subcutaneous, intracutaneous, vertical and horizontal mattress sutures; rotation, transposition, and advancement of flaps; Z-plasty and W-plasty techniques; and split and full thickness skin graft harvesting (Figures 1-3). The resected tissue is fixed onto a wooden block as described by Gürünlüoğlu et al 1 and sterilized with povidone-iodine solution. The resident performs the surgical maneuvers wearing sterile surgical gloves, which from our point of view is important when working with surgical instruments.
View of the resected breast tissue fixed onto a wooden block immediately following breast reduction surgery
The model gives the residents the opportunity to practice the elevation of a full thickness skin graft
Different suturing techniques, including horizontal mattress suture (at the bottom) and basic concepts of local flap surgery, including its planning, elevation, and suturation steps (at the center) can be practiced on this block of tissue as a realistic simulation
The only obvious disadvantage of this teaching model seems to be the lack of active bleeding during the surgical intervention, which without a doubt is another important element for gaining experience in these basic surgical manipulations. Nevertheless, the presented model offers a great opportunity to fresh residents of plastic surgery to practice basic surgical maneuvers in an almost real simulation and without the anxiety of causing damage to a live patient.
The utilization of the resected skin and subcutaneous tissue material acquired from post–bariatric surgery patients promises to be a suitable and efficient method for plastic surgery residents to practice and improve their surgical skills.