Teaching ear reconstruction using an alloplastic carving model.

BACKGROUND

Ear reconstruction is challenging surgery, often with poor outcomes. Our purpose was to develop a surgical training model for auricular reconstruction.

METHODS

Silicone costal cartilage models were incorporated in a workshop-based instructional program. Trainees were randomly divided. Workshop group (WG) participated in an interactive session, carving frameworks under supervision. Nonworkshop group (NWG) did not participate. Standard Nagata templates were used. Two further frameworks were created, first with supervision then without. Groups were combined after the first carving because of frustration in the NWG. Assessment was completed by 3 microtia surgeons from 2 different centers, blinded to framework origin. Frameworks were rated out of 10 using Likert and visual analog scales. Results were examined using SPSS (version 14), with t test, ANOVA, and Bonferroni post hoc analyses.

RESULTS

Cartilaginous frameworks from the WG scored better for the first carving (WG 5.5 vs NWG 4.4), the NWG improved for the second carving (WG 6.6 vs NWG 6.5), and both groups scored lower with the third unsupervised carving (WG 5.9 vs NWG 5.6). Combined scores after 3 frameworks were not statistically significantly different between original groups. A statistically significant improvement was demonstrated for all carvers between sessions 1 and 2 (P ≤ 0.09), between sessions 1 and 3 (P ≤ 0.05), but not between sessions 2 and 3, thus suggesting the necessity of in vitro practice until high scores are achieved and maintained without supervision before embarking on in vivo carvings. Quality of carvings was not related to level of training.

CONCLUSIONS

An appropriate and applicable surgical training model and training method can aid in attaining skills necessary for successful auricular reconstruction.