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Microsurgery for All - Advances to an Accessible Microsurgical Training Platform for Internal Mammary Vessel Anastomosis
Ryan J. Bender
1, Rachel Rohrich
1, Ryan Lin
1, Kenneth Fan
1, David Song
1
1Plastic Surgery, Medstar Georgetown, Washington, DC, United States.
Background: Early microsurgery training for most plastic surgery residents involves anastomoses of artificial vessels pinned to a flat platform. This practice provides limited application to microsurgery within a depressed cavity, as is the case for internal mammary (IM) vessel anastomoses during microsurgical breast reconstruction. Given the rising access to 3D printers in the academic setting, our team develop an accessible microsurgical platform, using a 3D-printed model of the sternum and ribs, with customizable layers of gauze and foam tape to mimic the mastectomy skin flaps and the new addition of a 3D-printed retractor and simulation of the tissue flap
. Methods: A de-identified non-contrast CT Chest was used to generate a 3D model of the sternum and ribs, then printed in poly-lactic acid (PLA) with a 3D-printer (Ender 3). A modified Richardson retractor was designed and 3D-printed in similar fashion. Foam tape and 4x4 gauze were used to imitate soft tissue to mimic the mastectomy flaps, with foam tape and a IV bag of normal saline used to mimic the bulk of the DIEP flap. Practice vessels were generated from the cuffs of sterile gloves which were prepared into tubular segments. The components were then arranged to mimic IM vessel access as encountered in a DIEP flap. Residents practiced microsurgical anastomoses on the model, completing a survey of the model using a Likert scale.
Results: The designed components were printed in PLA for $1.00 per rib model and just under $1.00 per Richardson ($0.015/g filament). Plastic surgery residents utilized the model effectively, with the majority of participants noting increased competency and overall confidence after model use.
Conclusions: Our updated ultra-low cost model promotes preparation for the specific challenges of internal mammary vessel microsurgery, facilitating training within the anatomic confines of the third rib access site. Our model can be replicated worldwide by anyone with access to a 3D-printer and common medical supplies.
