title: Flap raising on pulsatile perfused cadaveric tissue: a novel method for surgical teaching and exercise.
abstract: Exercising flap raising procedures on cadavers is considered a prerequisite to prepare for clinical practise. To improve teaching and create conditions as realistic as possible, a perfusion device was developed providing pulsatile flow through the vessels of different donor sites. A plastic bag filled with red stained tab water was placed into a pump, which was driven by an electric motor. The bag was set under rhythmic compression with variable frequency and pressure. The pedicles of the radial forearm, anterolateral thigh, rectus abdominis, fibular and iliac crest flap were cannulated at the origin from their source arteries. Flap raising was performed under pulsatile perfusion in 15 fresh bodies and subsequently in 6 Thiel-embalmed cadavers during a flap raising course. We regularly observed staining of the skin and skin bleeding in fresh bodies and less reliable in embalmed cadavers. All flap pedicles showed pulsatile movements, and the radial pulse became palpable. Most perforators of the anterolateral thigh and osteocutaneous fibular flap could be identified by their pulse. Bleeding from bony tissue and venous return was seldom observed. We conclude that pulsatile perfusion of cadaveric tissue creates more realistic conditions for flap raising and improves teaching for beginners and advanced surgeons.
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Univ.-Prof. Dr. Dr. Klaus-Dietrich Wolff), Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 München, Germany. Electronic address: wolff@mkg.med.tum.de.
authors.forename: Klaus-Dietrich
authors.initials: KD
authors.lastname: Wolff
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Univ.-Prof. Dr. Dr. Klaus-Dietrich Wolff), Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 München, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Fichter
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Univ.-Prof. Dr. Dr. Klaus-Dietrich Wolff), Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 München, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Braun
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Univ.-Prof. Dr. Dr. Klaus-Dietrich Wolff), Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 München, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Bauer
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Univ.-Prof. Dr. Dr. Klaus-Dietrich Wolff), Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 München, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Humbs
mesh_terms: D001794:Blood Pressure / Q000502:physiology; D016025:Bone Transplantation / Q000379:methods; D002102:Cadaver; D005360:Fibula / Q000098:blood supply; D005542:Forearm / Q000098:blood supply; D058752:Free Tissue Flaps / Q000098:blood supply / Q000601:surgery*; D013502:General Surgery / Q000193:education*; D006801:Humans; D007085:Ilium / Q000098:blood supply; D061525:Perforator Flap / Q000098:blood supply / Q000601:surgery; D010477:Perfusion / Q000295:instrumentation; D011673:Pulsatile Flow / Q000502:physiology; D011674:Pulse; D017568:Rectus Abdominis / Q000098:blood supply; D012867:Skin / Q000098:blood supply; D016038:Skin Transplantation / Q000379:methods; D013663:Teaching / Q000379:methods*; D013848:Thigh / Q000098:blood supply
keywords: Cadaver; Flap raising; Pulsatile post-mortem perfusion; Thiel