Surgical Simulation Maximizing the Use of Fresh-Frozen Cadaveric Specimens: Examination of Tissue Integrity Using Ultrasound

Abstract

Background Arthroscopic surgical simulation, including the use of cadaveric tissue, is valuable for training orthopedic surgery residents. However, it is unclear how often fresh-frozen cadaveric tissue can be reused to provide a reproducible model for developing arthroscopic skills. Objective We determined the usefulness of ultrasound in evaluating tissue degradation in fresh-frozen shoulder and knee joints used for surgical simulation. Methods Between February 7 and April 11, 2017, orthopedic residents participated in 6 wet lab sessions during 1 rotation. Knee and shoulder specimens were subjected to ultrasound using a SonoSite Edge machine and a linear probe after each freeze-and-thaw cycle. Degradation of each structure was determined based on standards created for living tissue and comparisons to previous images of the same tissue before initial use. Results Ultrasonographic assessment of the 2 knee and 2 shoulder specimens revealed lost integrity in subcutaneous fat and muscle with evidence of increased hypoechoicity and loss of normal fiber orientation and density in all specimens examined. Tendons, ligaments, cartilage, iliotibial band, and bone did not lose integrity during freezing and thawing. Ultrasonographic assessment revealed no loss of joint structure integrity. However, the intra-articular work assigned for the simulation curriculum had been carried out to a degree that by the third use, little opportunity remained for further arthroscopic practice on that specimen. Conclusions In this study, ultrasound findings showed that fresh-frozen shoulder and knee specimens maintained structural integrity useful for simulation training after 3 cycles of freezing.

Current and potential use of fresh frozen cadaver in surgical training and anatomical education

“…Three studies (Bell et al, 2020; Fernandez‐Gibello et al, 2019; Giussani et al, 2017) reported the use of FFC in ultrasound‐related training. One article reported a pilot study on performing ultrasonography on the brain for neurosurgeons using FFCs.…”

“…FFCs were evaluated for its suitability in one study (Bell et al, 2020) engaging ultrasound examination. Arthroscopic surgery is an important part of orthopedic surgery.…”

“…Ultrasonography was used to assess the quality of the FFC to determine its suitability in surgical simulations. The results showed that the integrity of the tendons, ligaments, cartilage, iliotibial band, and bones of FFC was not significantly different from that in real patients (Bell et al, 2020). They also noted that the adequate reuse trials were up to three times, and after three cycles, degradation of cadavers led to an inadequate quality for further training (Bell et al, 2020).…”

A Curricular Model for Simulation Within Orthopaedic Residency Training

“…For example, 4 pelvis through toes specimens are used for pubic symphysis Open Reduction Internal Fixation, then hemisected to provide 8 hemipelvis through toes specimens that can be used twice more in total (but may be sectioned to allow separate uses of foot/ankle vs knee, etc). OHSU has found that cadaveric models can undergo up to 3 freeze/thaw cycles before cremation with acceptable muscle degradation that maintains educational viability 16 .…”