gms | German Medical Science

As with most veterinary schools within Australia, the authors were questioning the ethical validity and cadaver sustainability, together with the increasing financial burden to veterinary faculties on the continued use of fresh cadaveric tissue in the introduction of basic surgical techniques (Day 1 skills) to our DVM3 cohort.

This project looked at the specific outcomes required for basic day one surgical competency. The outcomes identified included aseptic technique, preparation of oneself and the patient, surgical draping, instrument handling, completion of a surgical incision through to the abdominal cavity and surgical closure of the abdominal incision, using a three layer technique.

Once outcomes were identified, the authors looked at traditional teaching methods on fresh cadaveric tissue or cadaver’s and considered whether a synthetic model could replace some of the practical classes that traditionally used fresh cadavers and if so, could it give an equal or reasonable learning experience to the novice surgeon.

Therefore the aim of the project was to develop a cost effect synthetic model, replicating the visual and tactility of a midline abdominal incision and closure, representative of a canine patient with the potential for placement of cadaveric material within its boundaries.

A suture training model (Figure 1 [Fig. 1]) constructed of a commercially available polyurethane foam wound dressing (Allevyn) was identified as being an ideal dermis and epidermis layer with the added value of having an outer water-proof layer which would allow students to practice patient preparation technique.

A variety of synthetic materials were tested for visual representation, texture and robustness for each subsequent layer required.

A loosely woven material resembling fat and interspersed with red silicone was selected for the subcutaneous tissue; then using varying amounts of the material we enabled changes to its thickness and number of linea blood vessels.

The body wall is composed of two pieces of dense foam “rectus muscles” enclosed in rip-proof nylon material to replicate the internal and external rectus sheaths with a small gap in between the foam pieces to imitate the linea alba. This entire piece was loosely glued to the “skin” layer.

The addition of a chinese food container beneath the model created an abdominal cavity that could hold cadaveric tissue and then integrated into a soft toy mannequin.

The model consists of a variety of synthetic materials selected on the basis of physical characteristics and suture pull-out strength, to replicate the handling and mechanical properties of the skin, subcutaneous tissues, and body wall, including the linea alba, internal and external rectus sheaths and rectus abdominus muscles.

The use of the model has been evaluated by students during practical classes in parallel with traditional cadaveric materials, and has been widely accepted as a model which can provide an opportunity to practice basic surgical techniques both within and outside the surgical teaching environment in a cost-effective manner.

This model has been shown to provide an acceptable alternative to cadaveric animal tissues in an integrated teaching program enabling the students to develop basic surgical techniques, thus reducing the number of animal required in the surgical teaching laboratory. The use of this model allows for early exposure to skills training ensuring that basic skills are mastered prior to exposure to valuable animal tissues and then live animals in neutering clinics and clinical practice.

The model is of additional value within the Clinical Skills Centre where students are self-directed and peer reviewed in their learning prior to the clinical skills hurdle exam in DVM3.