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Julienne A, Donatini G, Richer JP, Brèque C, Mordon S, Faure JP, Danion J, Bertheuil N, Leclère FM. [Flap harvest training on a new ultrarealistic simulation model: In-training operator feedback about a pulsating reperfused and reventilated cadaver Simlife®]. ANN CHIR PLAST ESTH 2021; 66:126-133. [PMID: 33707027 DOI: 10.1016/j.anplas.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The anatomical subject is still a key element to learn complex procedures in plastic surgery. We present here the evaluation of an in-training operator on a SIMLIFE® model, hyper realistic model consisting in human bodies donated to science equipped with pulsating recirculation and reventilation device. MATERIAL AND METHODS From February 2019 to October 2019, 8 forearm flaps with radial proximal pedicle were harvested by the learner on a SIMLIFE® model. Conditions were as close as possible to the operating room : asepsy, sterile draping, assistant and instrumentation including electrocoagulation. RESULTS The procedure was decomposed in 13 distinct steps. Mean total surgery time was 90,5±11,62minutes. There was only one case of arterial pedicle lesion resulting in major blood leak. Bleeding was measured by fake blood loss from the SIMLIFE® console. Mean intraoperatoy bleeding was 171±108 milliliters. We review pros and cons of this new technology particulary suited for complex plastic and reconstructive surgery training. CONCLUSION Using SIMLIFE® technology we have a new mean to train for complex procedures in plastic and reconstructive surgery. This new technology could be applied to numerous other surgical procedures. Broader applications are still limited by cost and cadaver use legislation.
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Affiliation(s)
- A Julienne
- Laboratoire d'anatomie et de simulation de l'université de Poitiers, ABS Lab-Bât D1, 6, rue de la Miletrie TSA-51115, 86073 Poitiers cedex 9, France; Department of Plastic & Reconstructive Surgery, Hand Surgery, Centre of Expertise for Sex Reassignment Surgery, University Hospital Poitiers, CHU de la Miletrie de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France.
| | - G Donatini
- Laboratoire d'anatomie et de simulation de l'université de Poitiers, ABS Lab-Bât D1, 6, rue de la Miletrie TSA-51115, 86073 Poitiers cedex 9, France; Department of General Surgery, University Hospital Poitiers, CHU de la Miletrie de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - J P Richer
- Laboratoire d'anatomie et de simulation de l'université de Poitiers, ABS Lab-Bât D1, 6, rue de la Miletrie TSA-51115, 86073 Poitiers cedex 9, France; Department of General Surgery, University Hospital Poitiers, CHU de la Miletrie de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - C Brèque
- Laboratoire d'anatomie et de simulation de l'université de Poitiers, ABS Lab-Bât D1, 6, rue de la Miletrie TSA-51115, 86073 Poitiers cedex 9, France
| | - S Mordon
- Inserm U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology, University Hospital Lille, Lille, France
| | - J P Faure
- Laboratoire d'anatomie et de simulation de l'université de Poitiers, ABS Lab-Bât D1, 6, rue de la Miletrie TSA-51115, 86073 Poitiers cedex 9, France; Department of General Surgery, University Hospital Poitiers, CHU de la Miletrie de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - J Danion
- Laboratoire d'anatomie et de simulation de l'université de Poitiers, ABS Lab-Bât D1, 6, rue de la Miletrie TSA-51115, 86073 Poitiers cedex 9, France; Department of General Surgery, University Hospital Poitiers, CHU de la Miletrie de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - N Bertheuil
- Department of plastic, reconstructive and aesthetic surgery, hospital Sud, university of Rennes 1, Rennes, France
| | - F M Leclère
- Laboratoire d'anatomie et de simulation de l'université de Poitiers, ABS Lab-Bât D1, 6, rue de la Miletrie TSA-51115, 86073 Poitiers cedex 9, France; Department of Plastic & Reconstructive Surgery, Hand Surgery, Centre of Expertise for Sex Reassignment Surgery, University Hospital Poitiers, CHU de la Miletrie de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France; Inserm U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology, University Hospital Lille, Lille, France
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Boucher F, Brosset S, Mojallal AA, Braye F, Chateau J, Morel Journel N. [Phalloplasty: Microsurgical options and management algorithm]. ANN CHIR PLAST ESTH 2017; 62:617-624. [PMID: 28456428 DOI: 10.1016/j.anplas.2017.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 03/27/2017] [Indexed: 11/18/2022]
Abstract
The free radial forearm flap is considered as the gold standard in penile reconstruction for good functional and aesthetic results. The scar on donor site could be considered as pathognomonic of their situation by transsexual patients. The development of microsurgical flaps provides new therapeutic options. This options are discussed and a therapeutic algorithm is presented. The main techniques used are the pedicled anterolateral thigh perforator flap and free muscle sparing latissimus dorsi flap. Principal criteria are listed, the choice of patient and the local anatomical conditions are the most important. Antebrachial flap stay the first choice. In case of non-feasibility of this flap, phalloplasty with pedicle ALT flap or free MSLD flap will be proposed. Urethral reconstruction will be done by a narrow free forearm flap or by a delayed thin skin graft or buccal mucosa graft. Microsurgical phalloplasty options are not limited to the forearm flap. Satisfactory results can be obtained using alternative procedure. The use of a therapeutic algorithm allows to choose the most optimal solution for each patient.
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Affiliation(s)
- F Boucher
- Service de chirurgie plastique, reconstructrice et esthétique, hôpital de la Croix-Rousse, hospices Civils de Lyon, 103, grande rue de la Croix-Rousse, 69004 Lyon, France.
| | - S Brosset
- Service de chirurgie plastique, reconstructrice et esthétique, hôpital de la Croix-Rousse, hospices Civils de Lyon, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
| | - A A Mojallal
- Service de chirurgie plastique, reconstructrice et esthétique, hôpital de la Croix-Rousse, hospices Civils de Lyon, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
| | - F Braye
- Service de chirurgie plastique, reconstructrice et esthétique, hôpital de la Croix-Rousse, hospices Civils de Lyon, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
| | - J Chateau
- Service de chirurgie plastique, reconstructrice et esthétique, hôpital de la Croix-Rousse, hospices Civils de Lyon, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
| | - N Morel Journel
- Service d'urologie, centre hospitalier Lyon Sud, hospices civils de Lyon, Lyon, France
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