title: Porcine model for free-flap breast reconstruction training.
abstract: BACKGROUND
  Free-flap breast reconstruction is a challenging surgical procedure with a steep learning curve. A reproducible large animal model could be relevant for free-flap harvesting and microsurgical anastomosis training. The aim of this study was to assess the feasibility of a porcine model for free-flap breast reconstruction.
  
  
  METHODS
  Three female pigs were placed under general anesthesia in order to study feasibility and estimate relevance for training. The deep inferior epigastric perforator (DIEP) flap, the transverse musculocutaneous gracilis (TMG) flap, and the superior gluteal artery perforator (SGAP) flap were harvested and anastomosed to the internal thoracic vessels. Differences were noted between pig and human anatomy, and the surgical procedure was adapted to build training models.
  
  
  RESULTS
  Under a more prominent anterior thoracic wall, the internal thoracic vessels were slightly deeper and larger than in human anatomy. The DIEP flap was never feasible in the porcine model. However, the superior epigastric artery perforator (SEAP) flap showed anatomical similarity with the human DIEP flap, and it proved to be suitable for an inverted training model. The porcine TMG flap harvesting was close to the human one, reproducing specific dissection and anastomotic difficulties. The SGAP flap was not a muscular perforator flap in pigs but a septocutaneous flap. Because of the thinness of the hypodermal fat, porcine flaps were not considered adequate training models for breast-mound shaping.
  
  
  CONCLUSIONS
  Despite any anatomical variations, the pig has proven to be a suitable training model for free-flap harvesting and transfer in the field of breast reconstruction.
authors.affiliation: Department of Plastic Surgery, University Hospital of Strasbourg, Strasbourg, France. Electronic address: frederic.bodin@chru-strasbourg.fr.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Bodin
authors.affiliation: IRCAD, Research Institute Against Cancer of the Digestive Tract, Strasbourg, France; IHU-Strasbourg, Minimally Invasive Image-Guided Surgical Institute, Strasbourg, France.
authors.forename: Michele
authors.initials: M
authors.lastname: Diana
authors.affiliation: Department of Plastic Surgery, University Hospital of Strasbourg, Strasbourg, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Koutsomanis
authors.affiliation: Department of Plastic Surgery, University Hospital of Strasbourg, Strasbourg, France.
authors.forename: Emeric
authors.initials: E
authors.lastname: Robert
authors.affiliation: IRCAD, Research Institute Against Cancer of the Digestive Tract, Strasbourg, France; IHU-Strasbourg, Minimally Invasive Image-Guided Surgical Institute, Strasbourg, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Marescaux
authors.affiliation: Department of Plastic Surgery, University Hospital of Strasbourg, Strasbourg, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Bruant-Rodier
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D016462:Mammaplasty / Q000193:education* / Q000379:methods; D013518:Surgery, Plastic / Q000193:education*; D013552:Swine
keywords: Breast reconstruction; Free flap; Learning curve; Microsurgery; Porcine model; Surgical training models