C. B. Horn1, A. Coleoglou Centeno1, M. M. Frisella1, C. M. Donald1, G. V. Bochicchio1, S. R. Eaton1, J. P. Kirby1, L. J. Punch1 1Washington University,Department Of Surgery,St. Louis, MO, USA
Introduction: Negative pressure therapy (NPT) is an increasingly important tool in the healing and management of soft tissue injuries, infections and wounds. However there are few hands-on training models available to teach the necessary skills for the safe and effective application of NPT. As part a Visiting Preceptorship in Acute Care Surgery, we attempted to develop a cadaveric model, for use in training on NPT application.
Methods: The course consisted of didactic instruction by practicing physicians, operating room demonstration of NPT application and a hands-on laboratory consisting of cadaveric models of common scenarios where NPT could be applied. Two cadavers were prepared for each course. Each cadaver received a 10 centimeter laceration to the right leg, a 10cm x 3cm x 3cm debridement to the right inguinal region, medial and lateral left leg fasciotomies and a 15 x 6 superficial lesion. One cadaver received a laparotomy and was simply left open. The other cadaver received a midline laparotomy with cannulation of the bowel and debridement of the abdominal wall soft tissue so as to create an enteroatmospheric fistula (EAF) with subsequent closure of the fascia. Teams of two physician assistants (PAs) or nurse practitioners (NPs) and course facilitator applied NPT to all injuries. Course surveys were completed by all participants.
Results: Wounds were successfully created to simulate skin graft donor sites (figure 1), necrotizing soft tissue infections post debridement, partially closed fasciotomies (figure 2), open abdomens, lacerations and EAF (figure 3). NPT was successfully applied to all models by participating PA and NPs. All 9 (100%) participants completed course surveys; 8 (88.9%) participants stated that the course would change their clinical care; 9 (100%) participants rated the lab as “excellent” overall.
Figure 1. 1a. Lower extremity skin donor site model. 1b. Partially closed fasciotomy model. 1c. Enteroatmospheric fistula model. Note exposed loop of small bowel.
Conclusion: We have developed a cadaveric model for use in NPT application training for a variety of clinical situations. The initial response to the training was positive, however we acknowledge significant methodological limitations, including lack of pre- and post- course comparison and lack of evaluation of NP and PA competency. Future work will aim to evaluate this model’s effect on trainee competence.
