Flexor tendon repair in perfect safety

Abstract

When summarising the principles behind successful zone II flexor tendon repair surgery, technical perfection through experience appears of prime importance. The authors present a device intended to allow inexperienced surgeons to gain the necessary skill in a laboratory environment. The detail of the practicalities regarding construction and use of this "surgical training simulator" are specifically addressed. Conclusions are drawn after four years of experience with the device, and extension of the simulated training concept to other fields in hand surgery is recommended.

Simulation in Hand Surgery: A Literature Review

“…Historically tendon repair techniques for the hand were taught using divided pig tendons either in vivo or secured on a cork board [12]. Flemming et al made the first reported tendon repair simulator in 1994; they used a pediatric Foley catheter to simulate a flexor tendon injury with wooden pieces and tape simulating phalanx and pulley system, respectively, in the finger [13] (Fig. 2b).…”

Simulation in Upper and Lower Limb Trauma Skill Acquisition

“…Forty-six simulators were physical synthetic structures, the injury could be repaired with visual and tactile feedback on completion, 13–15,17–19,21–24,26,27,29,30,32,33,35–37,40–59,61–63,65–67,70 and 17 of the simulators reacted with virtual visual representations, such as bleeding or real-time x-ray of a nail insertion, all of which could be erased for the next user; most of these were digitally based 16,20,25,28,31,34,38,39,60,64,68,69,71–75 . Eight studies referred to the features of increasing difficulty of the task built into the simulator 34,49–52,58,65,68,71 . This usually involved, for example, decreasing the size of a vessel and therefore difficulty of repair or choosing a more difficult part of the bone for fracture repair.…”

“…In this review, 11 of the studies described full-task trainers 35,38,40,55,65,66,68,70,72–75 and 52 described a part-task trainer who focused on a particular part of the procedure 13–34,36,37,39,41–54,56–64,67,69,71,73 …”

“…For example, skin has been represented by a surgical foam dressing, and tendons have been made from rolled 3M micro foam, cotton dental rolls, and a Foley catheter. 27,30,32,34 Nerves have been simulated using a hand towel in an infant feeding tube and microvascular simulators using latex gloves, parafilm stretched over a lid, and paperclips glued to beads. 36,52,54,58 It is not shown that the simulators constructed from off-the-shelf materials are more or less superior to the simulators made from more considered construction, such as taking tissue elastic properties into consideration.…”

“…Of the studies describing part-task trainers, 29 are pure technical descriptions of simple simulators constructed by the author from materials readily available in the operating theater setting or from a hardware store. For example, skin has been represented by a surgical foam dressing, and tendons have been made from rolled 3M micro foam, cotton dental rolls, and a Foley catheter 27,30,32,34 . Nerves have been simulated using a hand towel in an infant feeding tube and microvascular simulators using latex gloves, parafilm stretched over a lid, and paperclips glued to beads 36,52,54,58 .…”