Efficacy of a perfused cadaver model for simulated trauma resuscitation in advanced surgical skills training

Water-soluble dye staining of the flap nutrient artery and its perforator branch in cadavers embalmed using saturated salt solution and urea methods: does demonstration using a dye-stained cadaver increase a trainee's level of skill acquisition?

Cadaveric surgical training (CST) can safely improve surgical skill. Recently, various innovations have made surgical training more realistic. Saturated salt solution (SSS) and urea methods are useful for plastic surgery training, because they better preserve the color and texture of soft tissues than formalin fixation (FA). Microvessels are invisible to the naked eye, and in this study, we visualized skin perforators by injecting dye into the flaps of nutrient vessels during hand and foot surgery. During each CST session, the instructor used three cadavers for demonstration. From 2017 to 2021, these cadavers were not stained, whereas from 2022 to 2023, the cadavers were stained to enhance the visualization of nutrient and perforating vessels. We compared the self-rated skill gains of participants who observed demonstrations on unstained cadavers from 2017 to 2021 and participants who observed demonstrations on stained cadavers from 2022 to 2023. Among 36 participants from the 2022-2023 group, 28 rated the staining of nutrient vessels and perforating branches as adequate. Of 32 participants, 29 preferred the use of dyed cadavers during training. Trainee skill increase for the digital artery flap, reverse digital artery flap, and dorsal metacarpal artery perforator flap was significantly higher in 2022-2023 (with stained cadavers) than in the earlier course without stained cadavers. SSS-fixed and urea-treated cadavers combined with vascular staining may be useful training models for flap elevation.

Body donor reperfusion and re-ventilation in medical training: an Italian study testing SimLife®

Background

Medical simulations have emerged as a valuable tool in anatomical-medical training, allowing healthcare professionals to gain hands-on experience in a controlled and safe environment. One such simulation platform is SimLife®, which uses the Pulse for Practice (P4P) system to enable realistic restoration of airflow ("re-ventilation") and blood flow ("revascularization") in bodies donated to science.

Objective

This study aimed to evaluate the feasibility of introducing SimLife® technology in Italy. Additionally, it assessed the impact of this technology across various medical specialties, utilizing a minimal number of donated bodies.

Methods

The study utilized the existing body donation program and dissection rooms at the Anatomy Center of the University of Bologna. 62 participants from 13 medical specialties performed simulations using the SimLife® P4P platform. Post-simulation, structured interviews were used to collect data on the interventions performed, participant perceptions of the technology's usefulness, enjoyment, and willingness to repeat the experience, as well as critical issues encountered.

Results

Key findings include that 86% of participants rated SimLife® technology as extremely useful for post-lauream training, while 84% found it highly beneficial for team-building activities. A total of 31 interventions were successfully performed across various anatomical regions, with participants reporting high satisfaction and a strong willingness to repeat the simulation experience.

Conclusion

The findings support the effectiveness of SimLife® technology for body donor re-ventilation and revascularization, reinforcing its value for medical training across various specialties.

Lessons Learned: Large-Scale Perfused Cadaver Training in Three Different Curricular Environments

BACKGROUND

Perfused cadavers are viable training models for operating room surgical skills, increasing fidelity of vascular anatomy, dissection, and tissue handling. In addition, perfused cadavers may have benefits in military medical training environments with a focus on hemorrhage control and vascular access.

OBJECTIVES

We created a large-scale training exercise with perfused cadavers in three different environments and aim to share the curricular design and feedback from the exercise.

METHODS

We conducted a 4-day simulation training exercise with 13 perfused cadavers in 3 different environments: hospital environment, the austere echelons of care environment, and a controlled-settings tent for hemorrhage control and needle decompression training. Through an anonymous online survey and an after-action review (AAR), we elicited feedback on advantages, disadvantages, costs, and comparison to models of porcine and fresh cadavers for procedures and existing courses.

RESULTS

A total of 324 participants were trained with 13 perfused cadavers for over 4 days from a variety of specialties and on different procedures and surgical skills. Based on 130 respondents to the survey and the AAR, perfused cadavers were rated to have realistic arterial bleeding and bleeding control training. In addition, perfused cadavers provided increased realism and fidelity for surgical skills. There were disadvantages of logistical requirements, cleanup, costs, and mobility.

CONCLUSION

Perfused cadavers can be implemented effectively for hemorrhage control training, surgical and procedure skills, and even exercises in austere environments, but require significant logistical and planning considerations. The training value is maximized with a progressive curriculum from hemorrhage control iterations to more invasive surgical procedures, such as thoracotomy and exploratory laparotomy.

Red line the red line: Optimizing emergency medicine physicians and surgeons collaborative roles on trauma teams

ABSTRACT

It has long been the standard for surgical and EM teams to both be present upon patient arrival and work together for the sickest trauma patients, yielding improved outcomes. It is important to dismantle divisive perceptions, confront system constraints, and promote new strategies that optimize the engagement of trauma team members. The focus should be on the patient, whose injury care starts with prevention and extends seamlessly through prehospital, hospital and rehabilitation.The authors address several myths that impact collaborative teamwork among emergency medicine physician and surgeons.Leaders, especially at GME sites, need to foster collaborative relationships, rather than adversarial. The red line mentality is a divisive construct that should be dismantled.