3D Printed Chest Wall: A Tool for Advanced Microsurgical Training Simulating Depth and Limited View

Abstract

Summary: The deep inferior epigastric perforator (DIEP) flap has become the free flap of choice for autologous breast reconstruction. However, anastomoses of DIEP pedicles to internal mammary vessels in the chest wall are difficult due to restricted access and the depth of the vessels. Successful performance of such demanding procedures necessitates advanced requirements for microsurgical training models. The current chicken thigh model has been used to acquire microsurgical skills, allowing early learning curve trainees to practice repeatedly in inconsequential environments. Despite the increasing use of this model for training purposes, the resemblance to a clinical environment is tenuous. Such models should include anastomosis practice within the depth where the recipient vessels are located. To address this, we developed a three-dimensional (3D) printed chest wall as an addition to the current chicken thigh model, which reliably mimics the complexity of the anastomosis performed during DIEP breast reconstruction. This form of rapid prototyping facilitates a newfound ability for early learning curve trainees to exercise end-to-end anastomoses on vessels located with variable depths. Our enhancement of the current chicken thigh model is simple, cost-effective and offers a significantly more realistic resemblance to a clinical situation.

Innovative Clinical Scenario Simulator for Step-by-Step Microsurgical Training

“…The tasks in these 10 steps were accomplished using various models involving latex materials, pig vessels, and living rat vessels. Although several articles have emphasized single constraint for microsurgical training (e.g., a microsurgical space restrictor was reported by Wang et al 13 and a three-dimensional printed rib cage device was presented by Papavasiliou et al 14 ), there is no microsurgical training device on the market that can comprehensively simulate various clinical real-world scenarios. The aim of our training program was to accommodate changeable and complicated operative conditions.…”

Future of autologous breast reconstruction: a review of novel technological innovations

“…Nevertheless, this system's reliance on cabled leads connected to a control unit can be cumbersome, restrictive, and uncomfortable for patients [58] . These systems are also known to trigger false alarms due to many inevitable factors such as patient movement [59] . Addressing these challenges, the novel ViOptix Intra.Ox handheld device was developed for more accurate and portable assessments.…”

Three-Dimensional Printing in Breast Reconstruction: Current and Promising Applications

“…Mehta et al applied 3D printing to autologous reconstructive breast surgery by creating a patient-specific model that helped teach DIEP flap breast reconstruction to trainee surgeons who used the model preoperatively and postoperatively to visualize the intramuscular path of the deep inferior epigastric perforator vessels [ 56 ]. Papavasiliou et al developed a 3D printed chest wall as an adjunct to the current chicken thigh model that mimics the anastomosis performed during DIEP breast reconstruction, representing a simple and cost-effective enhancement that provides a significantly more realistic resemblance to a clinical situation than the original model [ 98 ]. Lastly, Lim et al reported the use of a novel simulator with different breast volumes and ptosis grades in a single model for teaching marking in oncoplastic surgery [ 99 ].…”