Basic Plastic Surgery Training Using Human Skin

Sir:

To avoid harming the physical integrity of the human being, it is necessary to practice surgical procedures in synthetic, devitalized, or animal material before attempting them in patients. The continuous training has the goal of improving the experienced surgeon’s skills, to serve as a teaching activity, and to encourage interest by new medical students. Even with the entire aforementioned structure, it is fundamental to have a well-defined methodology with which to perform the procedure.^1–4 We describe a new basic training model for plastic surgery using human cutaneous tissue obtained from abdominal dermolipectomies.

This study was performed in the Surgical Technique and Experimental Surgery Laboratory of the Surgery Department of Santa Casa de São Paulo, Faculty of Medical Sciences. The skin belonged to patients who underwent abdominal dermolipectomy who had previously undergone bariatric surgery. The cutaneous resection was immediately sent to be frozen and, afterward, removed, defrosted, and heated to normal temperature for the training of the basic surgical procedures. The skin was kept frozen for a maximum period of 3 weeks. After use, the skin was sent for incineration and was not used for any other procedure.

The procedures that were performed were of knots and sutures, W-plasty and Z-plasty (Fig. 1), extraction of skin grafts (Fig. 2), and dissection of cutaneous flaps (Fig. 3).

Fig. 1.: Final appearance of the simple suture, W-plasty, and Z-plasty training.

Fig. 2.: Training to obtain a skin graft through the use of a Blair’s knife.

Fig. 3.: Training for local flap rotation. The flaps were traced over the skin, creating random cutaneous defects of different sizes and forms. The V-Y flap was documented, despite the fact that it was also possible to perform several types of cutaneous flaps.

Surgical training that uses laboratory animals such as rats, rabbits, dogs, and pigs is the most indicated for training surgeons because of the chance of unexpected occurrences, turning the activity closer to the reality of an actual operation. However, such activity presents a high cost because it requires a multidisciplinary team, anesthetics, and monitoring throughout the procedure. Before having contact with the animals, it is important to become familiarized with the instruments and basic surgical technique training. There are several methods described in the literature for surgical training without the need to use live animals.^1–5 The use of human skin in training of surgical techniques is a new method that has not yet been mentioned in the literature. Despite the process of freezing and defrosting, there was no alteration in the texture and consistency of the tissue. We considered this an important step in having a readily available material. The preference for skin from the abdominal area and from ex–morbidly obese patients is to obtain the maximum amount of material, which allows several types of training.

The training has advantages: low cost; identical material to that found during the medical activity; and that fact that different procedures can be performed in the same fragment of skin, from simple sutures to grafts and cutaneous flaps. In conclusion, the use of human cutaneous tissue obtained from abdominal dermolipectomies is an excellent method of training plastic surgeons.

Daniel Esteban, M.D.

Murillo F. Fraga, M.D.

Leandro G. Shimba

William Kikuchi, M.D.

Américo Helene Junior, M.D.

Santa Casa de São Paulo

Faculty of Medical Sciences

São Paulo, Brazil

ACKNOWLEDGMENT

The authors are grateful to the Support Center for Scientific Publications of Santa Casa de São Paulo Faculty of Medical Sciences for editorial assistance.