The Chicken Thigh Adductor Profundus Free Muscle Flap: A Novel Validated Non-Living Microsurgery Simulation Training Model

Abstract

BackgroundSimulation training is becoming an increasingly important component of skills acquisition in surgical specialties, including Plastic Surgery. Non-living simulation models have an established place in Plastic Surgical microsurgery training, and support the principles of replacement, reduction and refinement of animal use. A more sophisticated version of the basic chicken thigh microsurgery model has been developed to include dissection of a type 1-muscle flap and is described and validated here.MethodsA step-by-step dissection guide on how to perform the chicken thigh adductor profundus free muscle flap is demonstrated. Forty trainees performed the novel simulation muscle flap on the last day of a 5-day microsurgery course. Pre- and post-course microvascular anastomosis assessment, along with micro dissection and end product (anastomosis lapse index) assessment, demonstrated skills acquisition.ResultsThe average time to dissect the flap by novice trainees was 82±24 minutes, by core trainees 90±24 minutes, and by higher trainees 64±21 minutes (P=0.013). There was a statistically significant difference in the time to complete the anastomosis between the three levels of training (P=0.001) and there was a significant decrease in the time taken to perform the anastomosis following course completion (P<0.001). Anastomosis lapse index scores improved for all cohorts with post-test average anastomosis lapse index score of 3±1.4 (P<0.001).ConclusionsThe novel chicken thigh adductor profundus free muscle flap model demonstrates face and construct validity for the introduction of the principles of free tissue transfer. The low cost, constant, and reproducible anatomy makes this simulation model a recommended addition to any microsurgical training curriculum.

Microsurgery Training in Plastic Surgery

“…The chicken thigh model has demonstrated objective improvement in microvascular skills and a significant decrease in anastomosis time. 18 – 20 In this model, there was a statistically significant decrease between the time required to complete the first stitch (235 seconds, 95% confidence interval, 198–272 seconds) and the time required to complete the last stitch (120 seconds; 95% confidence interval, 92–149 seconds), an average 48.7% (115 seconds) decrease in time ( P < 0.001). Junior (postgraduate year 2–3) and senior (postgraduate year 4–5) residents had similar decreases in time (49.1% and 48.21%, respectively).…”

Microsurgery Training: Are the Live Models Era Coming in to the Tail? – A Literature Review

“…In case of microsurgical flap training, live models are popular and commonly used, however Ignacio J. Cifuentes et al [7] showed in their study that, ex vivo model (chicken leg) can be alternative of live model. In their study they have used 15 A study by Georgios Pafitanis et al [10] assessed forty trainees after a 5-day microsurgery course on non-living model (chicken thigh). Among the trainees, 11 were undergraduate medical students (novices), 12 were core surgical trainees, and 17 were higher specialty trainees.…”

Current status of simulation and training models in microsurgery: A systematic review

“…The chicken aorta model (Ramachandran et al, ) owing to its large lumen size (4 mm) is suitable to help build confidence in the novice microsurgeons. The chicken thigh model (Creighton et al, ; Schoeff et al, ; Pafitanis et al, ) demonstrated objective improvement in the microvascular surgical skills of the residents and a significant reduction in the time required to complete the anastomosis. Jeong et al () found that using the femoral neurovascular bundle of the chicken leg to practice the microanastomosis also demonstrated efficiency in anastomosis performance.…”