A Low-cost DIY Simulator for Flexor Tendon Repairs

INTRODUCTION

Simulation training represents an integral component to surgical training.^1–3 It is imperative for residents to practice and hone fine motor skills in a stress-free environment before attempting to operate on a patient. Although they represent an essential facet to surgical training, the commonly used simulation models are costly or difficult to set up. In this article, we describe a convenient, low-cost, self-assembled model to train flexor tendon repairs, that is intended to bridge the gap between theoretical knowledge and more sophisticated models, limiting the utilization and consumption of scarce or costly resources.

METHODS

To assemble the model, we used two glue sticks taped 0.5–1 cm apart on a plastic 30-cm ruler (Fig. 1). Sutures are intended to be placed in the substance of the glue sticks, which represents the tendon (Fig. 2). To create a visual representation of the suture entry and exit sites, a permanent marker is used to create dots on the glue sticks, functioning as a guide for the user to pass the suture material through. The arrangement of the dots is consistent with the technique being taught.

Fig. 1.

Our self-assembled model.

Fig. 2.

To create a visual representation of the suture entry and exit sites, a permanent marker is used to create dots on the glue sticks, functioning as a guide for the user to pass the suture material through.

RESULTS

Our self-assembled model is shown in Figure 1. The supplemental online video demonstrates our self-assembled model being used to practice the modified Kessler technique. (See Video [online], which demonstrates the self-assembled model being used to practice the modified Kessler technique.)

Video 1. This video demonstrates the self-assembled model being used to practice the modified kessler technique.

Download video file ^{(131.4MB, mp4)}

DISCUSSION

Traditionally, cadaveric porcine tendons have been used for flexor tendon simulation,^4,5 with various factors limiting their convenience and widespread use. Along with a number of ethical implications and religious objections, porcine models, although rare, carry a theoretical risk of transmitting zoonotic infections. Additional time and cost is required to procure and prepare them for use, and given its perishability, storing and disposal represents an integral part of handling such models. This can be time-, effort-, and/or financially-consuming.

We describe a self-assembled model consisting of glue sticks that are intended to represent a tendon. Additionally, we provide a visual representation of the steps required to achieve a given technique by marking the entry and exit sites of the suture. Our model is customizable to the technique being demonstrated. Due to its simplicity, reproducibility, low-cost, ease of storage, and ease of disposal, the convenience of our model is particularly noteworthy to medical students and junior doctors, especially those on rural placements, with limited access to a wet laboratory.

When compared with glue sticks, the advantage of porcine simulation models lies in the fact that they provide superior tissue resemblance of a real tendon, allowing the user to accustom to a more representative tissue handling and manipulation. Following solid registration of the steps required for a given repair technique using our model, residents can subsequently progress to practicing with porcine models for better tissue representation. This limits the utilization of scarce resources (eg, porcine models, cadaveric models) throughout the learning curve of a given tendon repair technique.

CONCLUSIONS

Glue sticks are a convenient method for practicing tendon repairs. They are easy to handle, store, and dispose of; they are accessible, reproducible, and reusable. Throughout the learning curve of a given technique, their use lies in conserving and limiting the use of nonexpendable resources. Their utilization serves to bridge the gap between theoretical knowledge and the use of more scarce or expensive practice resources (eg, 3D-printed or cadaveric models). Despite our subjective positive anecdotal experience, further studies are required to ascertain whether labeling the entry and exit sites translates to better recall in the operating room.