Addressing the Pandemic Training Deficiency: Filling the Void with Simulation in Facial Reconstruction

Abstract

Objective/Hypothesis To assess the use of a three‐dimensional (3D) printed, multilayer facial flap model for use in trainee education as an alternative method of teaching surgical techniques of facial reconstruction. Study Design Cohort study. Methods A 3D printed facial flap simulator was designed from a computed tomography scan and manufactured out of silicone for low‐cost, high‐fidelity simulation. This simulator was tested by a group of Otolaryngology–Head and Neck Surgery trainees at a single institution. The simulator group was compared to a control group who completed an exercise on a traditional paper facial flap exercise. Both groups underwent didactic lectures prior to completing their respective exercises. Pre‐ and post‐exercise Likert scale surveys measuring experience, understanding, effectiveness, and realism were completed by both groups. Central tendency, variability, and confidence intervals were measured to evaluate the outcomes. Results Trainees completing the facial flap simulator reported a statistically significant (p < 0.05) improvement in overall expertise in facial flap procedures, design of facial flaps, and excision of standing cutaneous deformities. No statistically significant improvement was seen in the control group. Conclusions Trainees found the facial flap simulator to be an effective and useful training tool with a high level of realism in surgical education of facial reconstruction. Surgical simulators can serve as an adjunct to trainee education, especially during extraordinary times such as the novel coronavirus disease 2019 pandemic, which significantly impacted surgical training. Level of Evidence NA Laryngoscope , 2021

Simulation models for learning local skin flap design and execution: A systematic review of the literature

“…The control group gave average to below average ratings across all survey domains. The average rating scale of 0 to 10 given by an experienced facial plastic surgeon based on the performance of both groups was 8.9 for the simulator group and 7.14 for the control group ( 2 ). Similarly, Powell et al developed a 3-mm skin depth and a 6-mm fat depth by using CT scan.…”

“…All these factors have contributed to limitations in practical surgical training, which have been further confounded by the COVID-19 pandemic. This has encouraged the use of simulated and model-based surgical training and education ( 2 ). Simulation training in modern teaching and surgical education allows trainees to practice procedures effectively and safely.…”

“…Simulation training in modern teaching and surgical education allows trainees to practice procedures effectively and safely. It can also have a positive impact on operative outcomes and can provide skills easily transferrable to the clinical setting ( 2 – 4 ).…”

“…Local flaps are extensively utilized in soft tissue reconstruction ( 2 ), providing wound closure when direct closure is not possible through the mobilization of adjacent skin and subcutaneous tissue ( 2 , 5 ). The design and execution of flaps is a highly demanding procedure with cognitive and technical difficulties, requiring the design of appropriate flaps with respect for the local anatomy to avoid distortion ( 6 , 7 ).…”

Impact of redeployment on core surgical trainees in response to the COVID-19 pandemic: a regional survey

“…There are numerous published examples of evidence-based simulation exercises that have excellent trainee feedback. For example, Yang et al 6 devised a simulated facial reconstruction training exercise in response to the COVID-19 training shortfall. They demonstrated statistically significant improvements in surgical skills in trainees who had received training on high-fidelity, low-cost 3D printed facial flap simulators versus a control group who used paper illustrations of the flap reconstruction technique.…”