Ethylene Vinyl Acetate (Foam): An Inexpensive and Useful Tool for Teaching Suture Techniques in Dermatologic Surgery

Abstract

The authors have indicated no significant interest with commercial supporters.D ermatology is now a medical-surgical specialty because of the increasing incidence of skin cancer, and skin diseases that must be treated using surgical means. Dermatologists must develop skills to treat benign and malignant lesions while maintaining function and aesthetics. To achieve this, residency programs have been urged to use novel teaching methods to train dermatologists in cutaneous surgery. Skin models that have traditionally been used for these purposes may be expensive, inaccessible, or impractical. We have developed a surgical model that is inexpensive, easily obtainable, and comparable with human skin for the training of dermatologic surgery. ObjectiveOur purpose was to demonstrate that ethylene vinyl acetate (EVA) is an inexpensive and useful tool for teaching suture techniques in dermatologic surgery. MethodsA dermatologic surgery professor gave a 60-minute theoretical and practical lecture on common surgical stitches (simple interrupted, running, horizontal and vertical mattress, interrupted buried, ''8'', three-and four-point corner, and half-buried horizontal stitches) to 15 dermatology residents. The techniques were thoroughly explained with images on color slides. The residents were then asked to draw the sutures to prove that they had learned the techniques. Afterwards, participants used EVA as a skin model to practice the sutures. The materials used included an 8-Â 6-inch sheet of EVA foam with linear incisions, a 5-0 nylon suture, and a surgical instrument kit that included forceps, needle holder, and cutting scissors. The residents were evaluated on their surgical abilities (handling of the needle holder, forceps, and foam and correct angle of entry of the needle) and the final result of the sutured incision. ResultsThe 15 residents were able to reproduce all of the stitches taught during the lecture. The consistency of the EVA allowed handling with the forceps and penetration by the needle without ripping the sheet. The thickness of the sheet allowed all of the superficial and deep stitches to be performed. Some examples are the superficial cuticular and threepoint corner stitch shown in Figures 1 and 2 and the deeper buried stitch (Figure 3). It also allowed proper eversion of the borders of the simulated linear wound. Students and professor were able to evaluate and rate the students' surgical skills with the final result. The residents showed interest and were

Teaching elliptical excision skills to novice medical students: A randomized controlled study comparing low- and high-fidelity bench models

“…[6] However, as the practice on fresh human cadavers and on live animals is associated with high costs, risks of infections, need of specialized facilities, and legal/ethical aspects, and the use of virtual reality simulators is hampered by the high costs and lack of access,[7] several low- and high-fidelity bench models have been described as teaching and learning tools. [891011121314151617181920]…”

“…In those training programs that use pig or chicken skins,[1112] in laboratories of surgical technique, the plates of ethylene-vinyl acetate[1617] or organic materials[19] can be adopted as an alternative complementary tool for training sessions at home. Thus, students can train under supervision of instructors in classrooms (concurrent feedback) and they can also practice at home, bringing the ethylene-vinyl acetate plates or organic material with them to resolve doubts with the instructor (summary feedback).…”

“…The adoption of oranges (organic bench model) and many sheets of ethylene-vinyl acetate glued together as low-fidelity simulation platforms during the training phase was carried out according to some principles previously described by our group[161920] and by others. [1718] Chicken legs and pig feet were used as high-fidelity simulation platforms according to some characteristics described by Khalil et al . [11] and by Purim,[12] respectively.…”

“…[67] These inanimate bench models vary widely regarding their level of fidelity (or “realism”) to living human patients. [7] High-fidelity bench models such as parts of postmortem animals (e.g., ox tongue, cattle digits, and pig, rat and chicken skins[8910111213]) are limited by high costs, low availability, potential for transmission of infectious disease, and ethical concerns[7]; and lower-fidelity bench models such as synthetic or organic materials (e.g., polyurethane foam sheet, synthetic ethylene-vinyl acetate, fruits and vegetables[914151617181920]) sacrifice “realism” for portability, lower costs, and potential for repetitive use. [7]…”

Training on synthetic ethylene-vinyl acetate bench model allows novice medical students to acquire suture skills

“…We selected two types of sutures 31 , because the possibility of training two and three-dimensional sutures seems to be one of the advantages of using the EVA bench model 11,19 .…”