Z-plasty training - Myocutaneous simulator for teaching suture and reconstructive surgery

It is important for veterinarians to be able to practice surgical techniques before performing surgical procedures. Many synthetic models have been described for suture training, including E.V.A. models, cloth frames and commercial silicone models. Because of the costs associated with imported models and the lack of more locally produced realistic models the author aimed to create a three-layered silicone model providing an accurate simulation of animal skin, subcutaneous and muscle layers. Animal models are described in terms of discrimination (where specific aspects of the model are very similar to a particular function in a real animal) or fidelity (general similarity of the model in appearance to a real animal). The model was assessed by veterinary surgeons for texture, resistance, elasticity, sensations during incision of each layer and the variety of sutures that could be performed. Following modification as suggested by the surgeons the model was tested again. Some surgeons suggested that the model was suitable for training in flap construction for reconstructive surgery, a procedure that in Brazil is commonly taught using animal cadavers. Other possibilities for the model include punch biopsy training and drain implantation. These techniques were possible because of the high discrimination in terms of elasticity and resistance between the model and real skin/ subcutaneous tissue. The flaps created included: H-plasty, Z-plasty, V-Y-plasty and advancement flaps. Apposition sutures (simple interrupted and sultan), everting sutures (Wolff and Donatti) and inverting sutures (Cushing and Gelly) were performed. Another benefit of this model is that the old sutures can be removed and the same incision reused. The use of such a model as a training tool has many advantages over cadavers which can be unpleasant to store and handle. In addition, the model is practical to store, and allows student training at any location, without the necessity for special facilities. The model construction is affordable and will offer many new training opportunities for Brazilian students.