AUTHOR=Hadjikyriacou Eleni , Goldsmith Thomas , Bowerman Frances I. , Dobbs Thomas D. , Whitaker Iain S. 

TITLE=Simulation models for learning local skin flap design and execution: A systematic review of the literature

JOURNAL=Frontiers in Surgery

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2022.918912

DOI=10.3389/fsurg.2022.918912

ISSN=2296-875X

ABSTRACT=Early exposure to practical skills in surgical training is essential in order to master technically demanding procedures, such as the design and execution of local skin flaps. This necessitates alternative methods of surgical skills training. To date there are no standardized or ideal simulation models for local skin flap teaching. This systematic review  summarizes and evaluates local skin flap simulation and teaching models published in the literature. A systematic review protocol was developed and undertaken in accordance with PRISMA guidelines. Key search terms encompassed both those for ‘local skin flaps’ and ‘models’ or ‘surgical simulation’. These were combined using Boolean logic and used to search Embase, Medline and the Cochrane Library. Studies were collected and screened according to the inclusion criteria. The final included articles were graded for their level of evidence and recommendation based on a modified educational Oxford Center for evidence-based medicine classification system and assessed according to the CRe-DEPTH tool for articles describing training interventions in healthcare professionals.  Five hundred forty nine articles were identified, resulting in the inclusion of 16 full text papers. Four articles used 3D simulators for local flaps teaching and training, whilst two articles described computer simulation as an alternative method for local flap practicing. Four models were silicone based, whilst gelatin, Allevyn dressings, foam rubber and ethylene -vinyl acetate based local flap simulators have also been described. Animal models such as pigs head, porcine skin, chicken leg and rat, as well as a training model based on  fresh human skin excised from body contouring procedures have all been described. Each simulation and teaching method was assessed by the group of candidates via a questionnaire or evaluation survey grading system. Most of the studies were graded as level of evidence 3 or 4.  Many methods of simulation for the design and execution of local skin flaps have been described but have been assessed only in small cohort numbers and larger candidate sizes and a standardized method for assessment are required. Further development and evaluation of promising high-fidelity models is required in order to improve training in such a complex area of surgery.