Surgical Training Model from Rubber Glove for Practicing Flap Design in Pollicization and Cleft Hand Reconstruction

Flap design for rare congenital hand anomalies such as pollicization and cleft hand reconstruction could be a problem for inexperienced surgeons. Practicing on surgical models would be beneficial for improvement of understanding flap design. In previous studies, a human cadaveric hand with amputated thumb or a resin hand mold without thumb was used as a surgical model for pollicization.1,2 Glove models glued with DuoDERM (ConvaTec, Oklahoma City, Okla.) and plastic hand models covered with pigmented latex layer are commonly used for practicing syndactyly separation3,4 and for practicing local flaps of the hand,5 respectively. In this study, we propose a surgical training model from rubber glove for practice of flap design in pollicization and cleft hand reconstruction (Figs. 1 and 2). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.Fig. 1.: Surgical training model from rubber gloves for practicing flap design. (Left) Pollicization model. (Right) Cleft hand model.Fig. 2.: Both models after practice. (Left) Pollicization model. (Right) Cleft hand model.Steps for model preparation are as follows: (1) use three surgical gloves for each model; (2) create a simulation of each type of anomaly by tying at the base of the thumb for the “pollicization model” and tying the middle and ring fingers together for the “cleft hand model”; (3) place the three tied gloves on the same hand; (4) turn all gloves inside to outside to create a smooth outer surface; (5) fill water into the innermost layer of the glove and tie at the opening; and (6) draw all finger nails and digital creases to create surface anatomical landmarks [See Video 1 (online), which shows a training model from rubber gloves for pollicization. See Video 2 (online), which shows rubber glove training models for pollicization and cleft hand reconstruction. {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video 1.","caption":"This video shows a training model from rubber gloves for pollicization.","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_3s6dk1gl"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video 2.","caption":"This video shows a training model from rubber gloves for cleft hand reconstruction.","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_oqehzg9d"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} During the practice session, we recommend identifying the areas of flap dissection with different colors. This process provides the trainee with understanding of the areas of each flap after transposition. The purpose for filling the innermost glove with fluid is because the water inside helps the trainee perform meticulous dissection at the superficial layer only without causing injury to the inner layer. For the pollicization model, the small finger is preferred for practice over the index finger because of avoidance of an irregular surface from knot-tying at the thumb. These models were used to teach 20 residents to perform flap design in pollicization and cleft hand reconstruction. The quality of these models was evaluated by using a five-point Likert questionnaire (from 5 = very satisfied to 1 = very unsatisfied). After practice, these models provided improvement in understanding of flap design (score, 5 of 5), improved surgical technique (score, 4.75 of 5), and overall satisfaction (score, 4.9 of 5). Problems we found during practice with these models were as follows: first, the innermost glove did not stay inside the other two gloves. This problem could be corrected at the step of reversing the gloves. Trainees must push the inner layer of the finger to the tip or blow the inner glove by mouth to help position the inner glove to remain inside the outer glove. Second, the outer layer slipped out from the inner glove (with water inside). This problem can be corrected by suturing, including all layers of the gloves, at the tip of the fingers to prevent slippage. In conclusion, training models from rubber gloves can help new surgeons understand flap design and flap transposition during pollicization and cleft hand reconstruction. Advantages of these models include low cost, easy preparation, and the use of readily available materials for practice any time. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article. No funding was received for this article. Pobe Luangjarmekorn, M.D.Vanasiri Kuptniratsaikul, M.D.Pravit Kitidumrongsook, M.D.Department of OrthopaedicsFaculty of MedicineChulalongkorn UniversityKing Chulalongkorn Memorial HospitalBangkok, Thailand