RESUMEN
PURPOSE: Residents' duty-hour regulations and the evolution of minimally invasive surgical techniques require more effective and efficient surgical skill teaching models. We used frozen-thawed human tissue remnants harvested during abdominoplasty or abdominal tissue-based breast reconstruction to allow for a medium-sized group workshop program, simulating a realistic surgical environment and visual/haptic feedback. METHODS: Full-thickness abdominal tissue (skin and subcutaneous fat) were donated from patients who underwent autologous breast reconstruction and gave consent to use their tissue for comprehensive research and medical educational purposes. Anonymized tissue was frozen-preserved and then thawed the day of the surgical skills workshop. A total of 53 residents completed 50-minute hands-on training in 3-to-5 person modules in four sessions of the workshop program. RESULTS: Thawed tissue regained almost normal texture and consistency. Structural integrity was also histologically confirmed. All participants were generally satisfied with the program, especially regarding the suture material provided. CONCLUSION: Frozen-thawed tissue remnants from abdominoplasty or autologous breast reconstruction could be preserved and used as a suture education material in medium-group workshops for surgery residents or medical students given anonymity and with proper consent guaranteed. This approach provided an excellent model maintaining relatively real anatomic structure and consistency with minimal cost.
Asunto(s)
Femenino , Humanos , Abdominoplastia , Anónimos y Seudónimos , Educación , Internado y Residencia , Mamoplastia , Control Social Formal , Estudiantes de Medicina , Suturas , Apoyo a la Formación ProfesionalRESUMEN
BACKGROUND: The most common surgical treatment for paralytic lagophthalmos is the placement of a weight implant in the upper eyelid; however, this technique confers the risks of implant visibility, implant extrusion, and entropion. In this study, we present a new technique of placing platinum weight implants between the levator aponeurosis and inner septum to decrease such complications. METHODS: A total of 37 patients with paralytic lagophthalmos were treated between March 2014 and January 2017 with platinum weight placement (mean follow-up, 520.1 days). After dissecting through the orbicularis oculi muscle, the tarsal plate and levator aponeurosis were exposed. The platinum weights (1.0–1.4 g) were fixed to the upper margin of the tarsal plate and placed underneath the orbital septum. RESULTS: Five patients could partially close their eye after surgery. The average distance between the upper eyelid and the lower eyelid when the eyes were closed was 1.12 mm. The rest of the patients were able to close their eye completely. Three patients patient developed allergic conjunctivitis after platinum weight insertion, which was managed with medication. None of the patients complained of discomfort in the upper eyelid after surgery. Visibility or extrusion of the implant were observed in three patients. CONCLUSIONS: Postseptal weight placement is a safe and reproducible method in both primary and secondary upper eyelid surgery for patients with paralytic lagophthalmos. It is a feasible method for preventing implant visibility, implant exposure, and entropion. Moreover, platinum is a better implant material than gold because of its smaller size and greater thinness.