Designing and utilising local flaps is a daunting skill for plastic surgery trainees. The ability to decipher the geometrical conundrum posed by local flaps is a fundamental skill, gained only through experience. With changes in training, and flap design courses costing in the order of £500–£1000, the need to find novel learning opportunities is increasingly paramount. We describe a simple, inexpensive method of practicing the design and execution of local flaps on excess tissue during breast reconstruction.
Technique
Using the deep inferior epigastric perforator or transverse rectus abdominis myocutaneous free flap for unilateral breast reconstruction typically results in the disposal of excess abdominal tissue. Abdominal skin, and subcutaneous fat are a realistic medium on which to practice flap design and construction ie Rhomboid flaps and C-V flaps for nipple reconstruction.
While still in theatre but using equipment and suture material that is no longer in use, the flap can be secured to a sterile trolley, and flap designs can be mapped around a fabricated lesion (Fig 1).
Figure 1.
A trainee practising C–V flap design and construction in theatre, using excess surgical equipment and suture material
Discussion
This technique offers a realistic and cost-neutral method for practicing local skin flaps while in theatre. The patient can be consented for the use of their excess abdominal tissue on a separate consent form. The tissue is then used for the duration of the procedure and not stored, and then disposed of in the usual manner. This provides an opportunity to supplement surgical portfolios through simulated work-based assessments.