Validating A Chicken Foot Model For Training Simulation Of Locoregional Flaps Of The Hand
Johnny Ionut Efanov, MD PhD1; Lan Anh T. Le, MD, MS (Surg)2; Siti KM. Yusoff, Dip (BMS)2; Omar Elsewify, MD3; Jin Xi Lim, MBBS, MRCS2; Alphonsus Khin Sze Chong, MBBS, MMed(Ortho), FAMS2
1Centre hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada; 2National University Hospital (NUH), Singapore, Singapore; 3McGill University Hospital Centre (MUHC), Montreal, QC, Canada
Introduction Locoregional flaps are important tools in the armamentarium of surgical options for soft tissue deficits in the hand. The ability to design, harvest and inset different configurations of flaps requires several hours of practice as part of surgical specialty training. The objective of this study was to validate a chicken foot model as a training simulator for locoregional flaps of the hand.
Materials and Methods Participants included medical students, interns and junior surgical residents who had minimal experience with locoregional flaps of the hand. During the first session, they were asked to complete an in-house questionnaire (Likert-5 score scale) on their level of comfort in performing six common locoregional flaps of the hand: double Z-plasty for 1st webspace release, five-flap Z-plasty for 2nd webspace release, V-Y advancement flap for fingertip defect, cross-finger flap for volar phalanx defect, and first dorsal metatarsal artery flap for thumb defect. During the same session, they performed these flaps on a chicken foot model without prior training. During a second session four weeks later, the participants were given one-on-one training with a hand surgery consultant, and they were subsequently required to perform these flaps on their own for a second time. The same in-house questionnaire was given to compare pre-training with post-training level of comfort. Video recordings were taken of each session, and analyzed by two independent reviewers for hand movements, markings, tissue handling, flap harvest, insetting and final results. The internal validity of the model was assessed using the Cronbach coefficient. To assess the external validity of the instrument, univariate and multivariate analyses were performed.
Results: A total of 10 trainees participated in this study. In-house questionnaires revealed improvement in familiarity, execution and confidence in performing these six locoregional flaps of the hand (mean pre-training score of 2.6 versus mean post-training score of 4.1). Interrater reliability of this model was “excellent” at 0.89. Univariate analysis revealed a correlation coefficient between scores and prior experience with these flaps of 0.77 (p<0.001). Multivariate analysis demonstrated statistically significant differences between scores of attending surgeons and trainees on this chicken foot model (p=0.006).
Conclusions: The chicken feet models for simulation of locoregional flaps of the hand have demonstrated internal and external validity. The authors believe that this easily accessible and inexpensive non-live animal model can be incorporated in training programs to teach common flaps of the hand to junior trainees.
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