Tendon repair simulation: a comparison of training models

Abstract

Introduction: Surgical training has undergone many changes in the last few decades from the apprenticeship model of the past and a focus currently on shift patterns and working time directives. These have placed greater stresses on the current surgical trainees to obtain training opportunities, thus increasing the role for simulation activities and models. There is a need for reproducible, low cost and realistic training models for all surgical subspecialties. These allow the training exercise to be undertaken at any time, with supervision, and in a safe environment without compromise to patient care. As a training model for tendon repair, we created a simulated tendon that we believe is an excellent alternative to cadaveric, porcine or other materials such as liquorice. Methods: Experienced trainees and consultants with exposure and experience in performing human tendon repair were asked to perform a simulated repair on each of three models: silicone bathroom sealant, porcine tendon and liquorice. Each model tendon was secured to a wooden board and cut at its midpoint. The models were 5 mm in diameter and between 5 and 10 cm long. Participants performed a modified Kessler repair using standard surgical instruments and a 3-0 monofilament suture, and rated each model using a five-point Likert scale to assess suture gliding, likeness to human tendon, tendon handling and usefulness for training. Results: The porcine tendon was considered the most realistic (90.5%); however, the silicone model was a close second (86.5%). Silicone compared well for handling (4.4/5) and was considered superior to liquorice on all points. Conclusion: Silicone sealant as a model tendon is cheap, reproducible and a satisfactory alternative to other models of tendon simulation repair, and can be used to provide training opportunities.

A qualitative study of seven simulation models for tendon repairs

“…The epitendinous suture is important in tendon repairs; it re-aligns the periphery of the transected tendon and adds strength to the repair (Wade et al, 1989). Some simulation models do not assess the efficacy of epitendinous sutures (Abdulal and Onyekwelu, 2016;Musbahi and Henton, 2019). This study illustrates some variation in scores for models between the core repair and the epitendinous.…”

“…A number of tendon repair simulation models have been described, including pig trotters and synthetic models such as drinking straws, catheters, liquorice, silicone sealant, dental rolls and fishing lures (Abdulal and Onyekwelu, 2016;Holmes et al, 2013;Ingraham et al, 2009;Musbahi and Henton, 2019;Tare, 2004). There is limited evidence about the comparative values of these simulation models for trainees.…”