0013 A Novel Training Model For Simulating Nerve Repair

Abstract

Background/context Nerve repair is the ‘bread and butter’ practical skill of a plastic surgery trainee. Yet when a trainee attends a microsurgery course the majority of time is spent focusing on vascular repair and anastomosis despite excellent access to cadaveric or live animal tissue, microsurgery instruments and microscopes. We present a novel method of teaching nerve repair using inexpensive and readily available materials by creating a simulation of a nerve for repair under loupe magnification in order to improve nerve repair techniques. Description of innovation or topic The nerve model is constructed by wrapping cling-film round a length of twine. The twine fibres represent the fascicles and the cling-film, the epineurium. This model can then be fixed to the table and divided transversely. Under microscopic or loupe guidance, the ‘epineural repair’ is performed by suturing the cling-film with a fine monofilament non-absorbable suture. The divided fibres of twine can be re-aligned in their pre-divided arrangement without tearing the cling-film. As competence of the procedure improves a number of these ‘nerves’ can be bundled together in a separate layer of cling-film acting as epineurium and the individual cling-film layers of each nerve model can then act as perineurium. Improvement/outcomes This nerve model is a useful teaching aid for microsurgical trainees that helps to develop hand-eye co-ordination, improve operative speed and tissue handling techniques. It is cost effective, easy to assemble and anatomically similar to a real nerve. We await results of trials on various grades of plastic surgery trainees to validate this model as an effective teaching tool. Take home message Our technique allows the development of essential microsurgical skills for nerve repair without the cost associated with the use of animal tissue. References Shah SHA, Wain RAJ, Syed S. A novel training model for nerve repair. Ann R Coll Surg Engl 2010; 92: 260 Furnas DW. Microsurgery and the community based plastic surgeon. Clin Plast Surg 1983; 10: 145–8 Fanua SP, Kim J, Shaw Wilgis EF. Alternative model for teaching microsurgery. Microsurgery 2001; 21:379–82