Anterolateral Thigh Flap in a Chicken Model: A Novel Perforator Training Model

Abstract

Background Preclinical training in perforator flap harvesting is typically conducted on living animal models; however, repeated training is not possible with these models because of ethical and/or economical constraints. We describe an anterolateral thigh flap (ALT flap) training model using chicken thigh that seems to be an appropriate training model prior, for example, to raise a perforator flap in a living rat or swine model. Methods A total of 10 chicken legs were used in this study. Six chicken legs were anatomically dissected to confirm the presence of the perforator and to identify the main vascular tree. In four chicken legs, a skin flap was planned based on the perforator and intramuscular dissection was performed under magnification. Results The perforator was identified in all dissections and was consistently found 3 cm above the line extending from the patella to the head of the femur in its third proximal. Proximally, the mean diameter of the artery and vein was 0.56 (σ = 0.04) and 0.84 (σ = 0.06) mm, respectively. The mean dissection time to raise the flap was 88 (σ = 7) min. Conclusion This is the first description of a nonliving biological simulation model for training in perforator flap dissection that mimics an ALT flap. As an ex vivo chicken model, it is a cost effective and readily accessible model suitable for repeated practice.

The Blue-Blood Porcine Chest Wall: A Novel Microsurgery Training Simulator for Internal Mammary Vessel Dissection and Anastomosis

“…11 Innovative training models have been created in many areas of microsurgery from microsurgical and supermicrosurgical anastomoses to harvesting of ALT flaps, but a model of internal mammary vessel dissection currently does not exist. 7,12 The domestic pig is an animal model used frequently in medical research for its anatomic and metabolic similarity to humans. [13][14][15][16][17] As a preclinical model, the importance of the domestic pig cannot be overstated.…”

Ex Vivo Ovine Model for Surgical and Microsurgical Training on Parotidectomy and Facial Nerve Reanimation: Proposal of Structured Training Program

“…The development of manual skills in several fields as general surgery, plastic surgery, urology, gynecology, and orthopedics have been extensively studied. 3,7,[15][16][17] Many theories have been formulated to understand the learning of manual skills and the development of surgical skills. Among learning models, one of the most effective has been described as "deliberate practice," where the individual must focus on a specific and defined task (usually identified by the tutor), which is repeated multiple times with continuous feedback by the trainer/tutor.…”

“…Limitations of the animal models are ethical or infectious problems (such as Q fever in sheep), especially when live animals are used, as reported also by Costa. 7 Those problems can be overcome by the use of ex vivo animal specimens.…”

“…Furthermore, the vivo or ex vivo animal model have been widely used for the microsurgical training. [4][5][6][7][8][9] The aim of this study is to explore the feasibility and efficacy of a surgical training model on ex vivo ovine head and neck, and to obtain the basic and advanced skills of parotid gland surgery and facial nerve reconstruction/reanimation in a safe environment.…”

Microsurgery Fellows' Impression of Clinical and Educational Offerings during Fellowship Year

“…16 The type of training models continues to grow, with the first description of a nonliving biological simulation using chicken legs for anterolateral thigh flap training. 17 For institutions that lack the available of dry and animal laboratory resources, alternative options exist. A randomized controlled trial based in London showed that training using either a jeweler's microscope or iPad produced comparable results to laboratory-based training.…”