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      Return of the cadaver : Key role of anatomic dissection for plastic surgery resident training

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          Successful Plastic Surgery Residency training is subjected to evolving society pressure of lower hourly work weeks imposed by external committees, labor laws, and increased public awareness of patient care quality. Although innovative measures for simulation training of surgery are appearing, there is also the realization that basic anatomy training should be re-enforced and cadaver dissection is of utmost importance for surgical techniques.

          In the development of new technology for implantable neurostimulatory electrodes for the management of phantom limb pain in amputee patients, a design of a cadaveric model has been developed with detailed steps for innovative transfascicular insertion of electrodes. Overall design for electrode and cable implantation transcutaneous was established and an operating protocol devised.

          Microsurgery of the nerves of the upper extremities for interfascicular electrode implantation is described for the first time. Design of electrode implantation in cadaver specimens was adapted with a trocar delivery of cables and electrodes transcutaneous and stabilization of the electrode by suturing along the nerve. In addition, the overall operating arena environment with specific positions of the multidisciplinary team necessary for implantable electrodes was elaborated to assure optimal operating conditions and procedures during the organization of a first-in-man implantation study.

          Overall importance of plastic surgery training for new and highly technical procedures is of importance and particularly there is a real need to continue actual cadaveric training due to patient variability for nerve anatomic structures.

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          Most cited references 20

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          The new recommendations on duty hours from the ACGME Task Force.

           E Amis,  ,  Andrew S. Day (2010)
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              Human cadavers Vs. multimedia simulation: A study of student learning in anatomy.

              Multimedia and simulation programs are increasingly being used for anatomy instruction, yet it remains unclear how learning with these technologies compares with learning with actual human cadavers. Using a multilevel, quasi-experimental-control design, this study compared the effects of "Anatomy and Physiology Revealed" (APR) multimedia learning system with a traditional undergraduate human cadaver laboratory. APR is a model-based multimedia simulation tool that uses high-resolution pictures to construct a prosected cadaver. APR also provides animations showing the function of specific anatomical structures. Results showed that the human cadaver laboratory offered a significant advantage over the multimedia simulation program on cadaver-based measures of identification and explanatory knowledge. These findings reinforce concerns that incorporating multimedia simulation into anatomy instruction requires careful alignment between learning tasks and performance measures. Findings also imply that additional pedagogical strategies are needed to support transfer from simulated to real-world application of anatomical knowledge.

                Author and article information

                Medicine (Baltimore)
                Medicine (Baltimore)
                Wolters Kluwer Health
                July 2017
                21 July 2017
                : 96
                : 29
                [a ]Plastic, Reconstructive and Hand Surgery Division, CHUV – Lausanne University Hospital, Lausanne, Switzerland
                [b ]Laboratory for Biomedical Microtechnology, University of Freiburg, Freiburg im Breisgau, Germany
                [c ]Education Unit, CHUV – Lausanne University Hospital, Lausanne, Switzerland.
                Author notes
                []Correspondence: Lee Ann Applegate, Plastic, Reconstructive and Hand Surgery Division, Unit of Regenerative Therapy, CHUV – Lausanne University Hospital, EPCR 02/ Chemin Croisettes 22, 1066 Epalinges, Switzerland (e-mail: Lee.Laurent-Applegate@ ).
                MD-D-17-02864 07528
                Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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