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DOI: 10.1016/J.JHSE.2007.05.008
A Simple Model for Hand Trauma TrainingDepartment of Plastic, Reconstructive and Hand Surgery, Pinderfields General Hospital, Wakefield, UK Correspondence: Miss. Claudia C. Malic, 31 Fairfield Court, Leeds LS17 8UA, U.K. Tel.: +44 7739791851; fax: +44 1924814938. E-mail:claudemalic{at}yahoo.co.uk
This paper introduces the use of fresh, uncooked chickens as a simple, easily accessible and inexpensive teaching model to simulate the conditions met in cases of human hand injury.
Key Words: surgical training • plastic surgery • simulator • chicken Laboratory based teaching is becoming an increasingly important part of, rather than an adjunct to, training (DoH, 2004). Most training workshops and courses rely on synthetic models, including the use of synthetic bones to teach the principles of fracture fixation. This study aimed to create a simple, easily accessible and inexpensive training model to simulate the conditions met in cases of human hand injury and explored the usefulness of fresh, uncooked chickens as a model in this respect.
Fresh chicken thighs were dissected and we found that femurs were similar in shape and size to human adult metacarpals (Figs 1 and 2). The length and mid-diaphyseal outer diameter of each bone was measured using a caliper.
Chicken femurs, devoid of all soft tissues, were placed on a sponge and stabilised on either end by elastic bands pinned to a cork board (Fig 3). The bones were fractured using a battery powered saw. Short oblique, long oblique and transverse fractures were simulated. The various fractures were then fixed using plates, lag screws and interosseous wiring.
A whole chicken thigh was mounted on a cork board to create a model more realistic to the clinical reality of the bones being covered by soft tissues. A longitudinal incision was made through the skin and muscle, down to bone. As before, the femurs were fractured using a saw and then fixed by the various techniques previously described. In order to practice Kirschner wiring, the incised wounds were tacked together with a suture. Wires were then inserted under radiological guidance through the skin and muscle. Reattachment of avulsed tendons and ligaments was simulated by exposing the scapulo-humeral joint of the chicken wing. The long biceps was divided at its origin and then re-attached using bone anchors. Traumatised, contaminated and oedematous wounds were simulated by creating incisions, rubbing gravel into the incision and injecting saline into the skin and muscles. Wound debridement and suturing techniques were then practised. These models were tested by the authors and evaluated in terms of ease of use and usefulness in comparison to other hand trauma training simulators.
Human metacarpal bones are convex dorsally and concave ventrally. The average adult human metacarpal has a mean length, mid-diaphyseal outer diameter and cortical thickness of 62.5, 8.2 and 2.2 mm, respectively (Wergedal et al., 2003). The mean femoral length, mid-diaphyseal outer diameter and cortical thickness of chicken femurs were 78.8 (range 75–83) mm, 9.4 (range 8.1–10.2) mm and 2.0 (range 1.8–2.2) mm, respectively. Plain X-rays of chicken femurs showed that the bone density was similar to that of adult human metacarpals. During manipulation, wiring and other methods of fixation, the chicken femurs did not fragment or show signs of weakening. On inserting screws, the difference in cortical and cancellous bone was detectable (Fig 3). As the K-wires or screws purchased on the opposite cortex, a definite change in resistance was noted, as in the clinical setting. We found the chicken to have better handling qualities than synthetic models in respect of fracture fixation, bone anchoring, tendon repair, wound debridement and suturing.
As part of continuing medical education and to augment clinical training in the operating theatre, junior trainees are required to attend basic surgical skills and specialty specific workshops and courses which involve hands on practice using synthetic simulators, live animals and/or cadavers Guidance on the Operation of the Animals (Scientific Procedures) Act (1986); Russell & Burch (1992); Smith & Boyd (1991). These courses are an invaluable adjunct to clinical education, allowing trainees to gain confidence and build on existing skills. It is also essential for trainees to practise surgical skills regularly in a laboratory setting within their local hospital environment. State of the art laboratories and simulators are expensive and require technical support. Consequently, alternative, inexpensive, readily available but high quality training models are required. The chicken model fulfils these criteria. The chicken as a training model was first described in 1981 by Govila, who advocated the use of fresh rather than frozen chickens because of their superior handling qualities (Govila, 1981). Since then, this model has been used to simulate procedures such as microvascular anastomosis, percutaneous nephrolithotomy and laparoscopic vesicourethral anastomosis (Galeano and Zarabini, 2001; Hammond et al., 2004; Krishnan et al., 2004; Nadu et al., 2003).
We would like to thank Synthes for their assistance. Received for publication June 28, 2006. Accepted for publication May 31, 2007.
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Abstract
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