an alternative model for teaching tendon repair and surgical skills in plastic surgery

JPRAS Open (2016) 12e15 Contents lists available at ScienceDirect JPRAS Open journal homepage: http://www.journals.elsevier.com/ jpras-open Short communication An alternative model for teaching tendon repair and surgical skills in plastic surgery S Abdulal*, Obi Onyekwelu Department of Burns and Plastic Surgery, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK a r t i c l e i n f o a b s t r a c t Article history: Received 24 October 2015 Accepted November 2015 Available online 13 January 2016 In the article we will describe the use of a simple, reproducible and practical urinary catheter model for tendon repair simulation The structure of the model gives a satisfactory imitation of a tendon's texture, contour and flexibility This model is easily stored and disposed of It is free of any ethical committee restrictions In addition, it can be reused and is easy to handle There are no disease transmission risks and one catheter can be divided into multiple segments such that several trainees can use one catheter at any one time, therefore saving on costs In addition, different techniques can be performed on the same model Tendon repair is an important surgical skill to be attained by all core surgical trainees; especially in Plastic and Orthopedic Surgery However, tendon repair simulation materials can be relatively expensive In the Basic Surgical Skills Course®, trainees learn tendon repair techniques using a pig's trotter The caveat to this is the difficulty in obtaining animal models, and ethical dilemmas that this presents A simple, effective and cheap method to practice tendon repair techniques is by dividing a Urinary Catheter into multiple pieces, which can be secured to cardboard or perspex using clips, staples, or pins The Catheter thus simulates a divided tendon, providing a pragmatic medium for practice The two ends can be opposed and repaired with various suture techniques Trainees will be able to practice different repair techniques, surgical skills as well as basic surgical principles The surgical skills include the handling of tissues and instruments effectively and Keywords: Training Tendon repair Surgical skills Alternative teaching Suture * Corresponding author E-mail addresses: sabria.abdulal@gmail.com (S Abdulal), obi.onyekwelu@nhs.net (O Onyekwelu) http://dx.doi.org/10.1016/j.jpra.2015.11.003 2352-5878/© 2016 The Authors Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/) S Abdulal, O Onyekwelu / JPRAS Open (2016) 12e15 13 safely, disposal of sharps, suture choice and use, suturing technique and knot tying and surgical dexterity Principles that can be demonstrated during the simulation session include planning operative approach and choosing appropriate instruments © 2016 The Authors Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/) In this article we will be describing the use of a simple, reproducible and practical urinary catheter model for tendon repair simulation The structure of the model gives a satisfactory imitation of a tendon's texture, contour and flexibility This model is easily stored and disposed of It is free of any ethical committee restrictions In addition, it can be reused and is easy to handle There are no disease transmission risks and one catheter can be divided into multiple segments such that several trainees can use one catheter at any one time, therefore saving on costs In addition, different techniques can be performed on the same model Tendon repair is an important surgical skill to be attained by all core surgical trainees; especially in Plastic and Orthopedic Surgery However, tendon repair simulation materials can be relatively Figure Requirements for simulation would include the catheter model, Perspex board and instrument set including Forceps, Needle holder, Suture-cutting scissors 3-0 and 5-0 (Round body needle) 14 S Abdulal, O Onyekwelu / JPRAS Open (2016) 12e15 expensive In the Basic Surgical Skills Course®, trainees learn tendon repair techniques using a pig's trotter The caveat to this is the difficulty in obtaining animal models, and ethical dilemmas that this presents A simple, effective and cheap method to practice tendon repair techniques is by dividing a urinary catheter into multiple pieces, which can be secured to cardboard or perspex using clips, staples, or pins (Figure 1) The catheter thus simulates a divided tendon, providing a pragmatic medium for practice The two ends can be opposed and repaired with various suture techniques We describe the use of this model with the Adelaide flexor tendon repair technique1 (Figure 2) Trainees will be able to practice different repair techniques, surgical skills as well as basic surgical principles The surgical skills include the handling of tissues and instruments effectively and safely, disposal of sharps, suture choice and use, suturing technique and knot tying and surgical dexterity Principles that can be demonstrated during the simulation session include planning operative approach and choosing appropriate instruments We are not aware of any publication that states the use of the urinary catheter to simulate tendon repair The urinary catheter is a device found ubiquitously in medical settings and is readily available When divided and fixed to a surface (e.g cardboard or Perspex), this can simulate the feel and structure of a tendon The ability to practice on this model equips the trainee in developing their surgical skills prior to undertaking tendon repair in vivo Figure Catheter model demonstrating Adelaide tendon repair technique S Abdulal, O Onyekwelu / JPRAS Open (2016) 12e15 15 Conflicts of interest statement None to declare Funding None Ethical approval Not required Reference Sandow MJ, McMahon M Active mobilisation following single cross grasp four-strand flexor tenorrhaphy (Adelaide repair) J Hand Surg Eur Vol [Internet] 2011;36:467e475  ... choice and use, suturing technique and knot tying and surgical dexterity Principles that can be demonstrated during the simulation session include planning operative approach and choosing appropriate... techniques can be performed on the same model Tendon repair is an important surgical skill to be attained by all core surgical trainees; especially in Plastic and Orthopedic Surgery However, tendon repair. .. effectively and safely, disposal of sharps, suture choice and use, suturing technique and knot tying and surgical dexterity Principles that can be demonstrated during the simulation session include planning