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J Reconstr Microsurg 2023; 39(04): 254-263
DOI: 10.1055/s-0041-1740957
Original Article

Simulating the IMA Recipient Site for DIEP Flap Surgery: A New Model for Dynamic Microsurgery Simulation with Real-Time Respiration and a Pilot Study

Natalia I. Ziolkowski
1   Department of Surgery, University of Toronto, Toronto, Ontario, Canada
,
Kimberly Z. Sun
2   Department of Surgery, Section of Plastics, Joseph Brant Memorial Hospital, Burlington, Ontario, Canada
,
Catherine McMillan
3   Department of Surgery, Division of Plastic & Reconstructive Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
,
Agnes Ryzynski
4   Sunnybrook Canadian Simulation Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
,
Laura Snell
3   Department of Surgery, Division of Plastic & Reconstructive Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
,
Joan E. Lipa
3   Department of Surgery, Division of Plastic & Reconstructive Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Abstract

Background Breast reconstruction (BR) using autologous free flaps has been shown to have numerous psychosocial and quality-of-life benefits. Unfortunately, the microsurgical learning curve is quite steep due to some unique operative challenges. Currently, there is no realistic simulation model that captures real-life respiratory excursion and the depth of internal mammary vessels within the compact recipient site. The purpose of this study was to delineate intraoperative measurements of depth and motion, describe the resulting simulation model, and conduct a pilot study evaluating the simulator as an educational resource.

Methods This is a single-center, ethics-approved study. For the intraoperative measurements, all consecutive patients undergoing free flap BR using internal mammary vessels as recipients were recruited. Patient and intraoperative factors as well as intraoperative measurements were recorded. A dynamic model was developed based on intraoperative parameters. For the pilot study, plastic and reconstructive surgery trainees were recruited to complete a hand-sewn internal mammary artery (IMA) anastomosis using the new simulator and completed objective questionnaires pre- and postsimulation. Subjective feedback was recorded and themes determined.

Results Fifteen operative sites were analyzed. Flap pocket was found to be between 4 and 5 cm in depth with vertical excursion of 3.7 ± 1.0mm and a respiratory rate of 9 to 14 breaths/minute. Previous radiation, rib space, body mass index (BMI), blood pressure, heart rate, tidal volume, and respiratory rate showed no correlation to vessel depth/excursion. Laterality, rib space, BMI, radiation, vitals, and tidal volume had no correlation with vessel movement. Twenty-two trainees were included in the pilot. An increase in confidence and mixed results for anxiety was reported.

Conclusion This study reports a novel microsurgical simulation model that provides a realistic deep inferior epigastric perforator free flap BR IMA anastomosis experience. It replicates movement of vessels in situ with real-time respiratory excursion and similar physical structures of the internal mammary system. This model shows promising results for increased use in microsurgical education.

Keywords

anastomosis - internal mammary artery - simulation


Publication History

Received: 07 May 2021

Accepted: 10 November 2021

Article published online:
27 April 2022

© 2022. Thieme. All rights reserved.

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