Flap raising on pulsatile perfused cadaveric tissue: A novel method for surgical teaching and exercise

Abstract Exercising flap raising procedures on cadavers is considered a prerequisite to prepare for clinical practise. To improve teaching and create conditions as realistic as possible, a perfusion device was developed providing pulsatile flow through the vessels of different donor sites. A plastic...

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Bibliographic Details
Published in:Journal of cranio-maxillo-facial surgery 2014-10, Vol.42 (7), p.1423-1427
Main Authors: Wolff, Klaus-Dietrich, Fichter, Andreas, Braun, Christian, Bauer, Florian, Humbs, Martin
Format: Article
Language:English
Subjects:
Blood Pressure - physiology
Bone Transplantation - methods
Cadaver
Dentistry
Fibula - blood supply
Flap raising
Forearm - blood supply
Free Tissue Flaps - blood supply
Free Tissue Flaps - surgery
General Surgery - education
Humans
Ilium - blood supply
Perforator Flap - blood supply
Perforator Flap - surgery
Perfusion - instrumentation
Pulsatile Flow - physiology
Pulsatile post-mortem perfusion
Pulse
Rectus Abdominis - blood supply
Skin - blood supply
Skin Transplantation - methods
Surgery
Teaching - methods
Thiel
Thigh - blood supply
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Summary:Abstract Exercising flap raising procedures on cadavers is considered a prerequisite to prepare for clinical practise. To improve teaching and create conditions as realistic as possible, a perfusion device was developed providing pulsatile flow through the vessels of different donor sites. A plastic bag filled with red stained tab water was placed into a pump, which was driven by an electric motor. The bag was set under rhythmic compression with variable frequency and pressure. The pedicles of the radial forearm, anterolateral thigh, rectus abdominis, fibular and iliac crest flap were cannulated at the origin from their source arteries. Flap raising was performed under pulsatile perfusion in 15 fresh bodies and subsequently in 6 Thiel-embalmed cadavers during a flap raising course. We regularly observed staining of the skin and skin bleeding in fresh bodies and less reliable in embalmed cadavers. All flap pedicles showed pulsatile movements, and the radial pulse became palpable. Most perforators of the anterolateral thigh and osteocutaneous fibular flap could be identified by their pulse. Bleeding from bony tissue and venous return was seldom observed. We conclude that pulsatile perfusion of cadaveric tissue creates more realistic conditions for flap raising and improves teaching for beginners and advanced surgeons.
ISSN:1010-5182
1878-4119
DOI:10.1016/j.jcms.2014.04.004