Sir:
In plastic and reconstructive surgery, raising the flap is an important skill
1
; but sometimes it is difficult for young plastic surgeons to detect and isolate the
vessels. However, only a few studies have focused on flap training using cadavers.
In these studies, researchers used formalin fixation techniques, which produced tissues
with rigidities too high to provide a realistic simulation of flap training.
2
Therefore, preservation methods such as fresh cadaver
3,4
and Thiel method
2
have been favored. Fresh cadaveric tissue is a superior model of simulation because
of its approximation of live tissue,
4
but it has many disadvantages such as high cost, limited use, and risk of infection.
1,2
Thiel-embalmed cadavers have life-like color and flexibility.
2
However, Thiel method is quite complicated and requires the use of several problematic
and expensive substances during its preservation process. In addition, Thiel-embalmed
cadavers have their drawbacks: muscular disintegration and limited time for dissection.
5
Recently, Hayashi et al
5
reported that the cadavers embalmed by the saturated salt solution (SSS) method, which
consisted of saturated sodium chloride, low-dose formaldehyde, phenol, glycerin, isopropyl
alcohol, and water, were not less suitable than Thiel-embalmed cadavers in several
skills training courses in acute care surgery. Therefore, the authors tried raising
several flaps in the SSS-cadavers for future use in flap training. Four SSS-embalmed
cadavers and 1 Thiel-embalmed cadaver were used for this study, and the procedures
were performed in an anatomical training room at Tokyo Medical University. All procedures
were performed by Takayuki Shirai (a plastic surgeon with 9 years of experience).
The cadavers were used 1–6 months after they had been preserved, and each cadaver
was used several times. The types of flaps made included the following: oblique triangular
flap, reverse digital artery island flap (Fig. 1), latissimus dorsi musculocutaneous
flap, superficial temporal fascia flap, nasolabial flap, and anterolateral thigh flap
(Fig. 2).
Fig. 1.
Reverse digital artery island flap.
Fig. 2.
Anterolateral thigh flap.
Because SSS-embalmed cadavers tend to have realistic skin and soft tissue, anatomical
structures were easy to identify and the operations could be performed very much as
in live patients (Figs. 1, 2). These features of SSS-embalmed cadavers were almost
identical to those in Thiel-embalmed cadavers. In addition, the vessels of the SSS-embalmed
cadavers were more expanded because of ample fluid, making our detection and isolation
of vessels and raising of flaps easier in them than in the Thiel-embalmed cadaver.
CONCLUSIONS
SSS-embalmed cadavers are sufficiently useful in flap training. The SSS method is
simple with a low infection risk and relatively low cost.
5
Furthermore, SSS-embalmed cadavers have availability for multiple uses and their vessels
can be easily detected. Our trial suggests that the characteristics of SSS-embalmed
cadaver may be ideal for trainees of plastic surgery.
ACKNOWLEDGMENTS
We thank Dr. Ning Qu, Dr. Naoyuki Hatayama, and Dr. Shuichi Hirai for reviewing and
providing useful comments to us preparing in our manuscript. We also thank Mr. Shinichi
Kawata and Mr. Koichi Koyama for their excellent technical assistance, and Ms. Yuki
Ogawa, Ms. Miyuki Kuramasu, and Ms. Keiko Kuwana for their excellent secretarial assistance.
DISCLOSURE
The authors have no financial interest to declare in relation to the content of this
article. This study was supported by JSPS KAKENHI Grant Number 26463257. The Article
Processing Charge was paid for by the authors.
Takayuki Shirai, MD
Department of Plastic SurgeryAsama General HospitalSaku-shi, Nagano, JapanDepartment
of AnatomyTokyo Medical UniversityShinjuku-ku, Tokyo, Japan
Shogo Hayashi, MD, PhD
Masahiro Itoh, MD, PhD
Department of AnatomyTokyo Medical UniversityShinjuku-ku, Tokyo, Japan