Op Smile Reconstruct

Reconstructive surgery is an essential component of well-developed surgical systems and is required to treat many conditions commonly encountered in low- and middle-income countries including congenital defects, burns, trauma, and cancer. The core procedure for treatment is often local flap surgery in which skin, fat, and/or muscle are transferred to the wound or reconstructive site from an adjacent part of the body. Currently, no reliable, accessible simulation platform exists to replicate local flap surgery. We propose an innovative device for surgical trainees with multiple, distinctly independent, and anatomically correct layers for reliable, high-fidelity flap surgery simulation along with a virtual education platform that contains training modules with interactive surgical videos and step-by-step testing programs specifically designed to facilitate self-directed learning and training in designing and performing these complex local flaps. In this way, surgical trainees will learn the planning and psycho-motor skills necessary to successfully execute these essential reconstructive surgeries

We propose a re-usable suction cup-secured simulation pad with multiple, distinct, and anatomically correct layers with realistic tissue properties from silicone and other readily-available materials for high-fidelity flap surgery simulation. Each layer represents a unique anatomic layer (i.e. skin, fat, muscle) that can be separated during surgical training to simulate the way flaps are incised, dissected, and mobilized in live surgery. Suction cups secure the pad to any underlying surface to eliminate movement of the device during surgical practice. It is double-sided so that trainees have twice the surface area to practice flaps making it re-usable, long-lasting, and space efficient. This component of our training platform is therefore simple, cost-effective, and easy-to-use for trainees who are looking to practice the design and technical execution of local reconstructive flaps. It will be accompanied by a virtual training system containing surgical videos with step-by-step instructions for each flap procedure that covers flap selection, design, surgical mobilization, and closure. These virtual modules will be interactive so trainees can assess their knowledge about each flap and master the core concepts prior to testing their surgical planning and psycho-motor skills on the simulation pad.

Reconstructive surgery using local flaps is an essential skill that surgeons rely on to successfully treat many highly-prevalent conditions encountered in Sub-Saharan Africa and other LMICs including trauma, burns, cancer, and congenital defects (e.g. cleft lip/palate). Local flap surgery (transfer of skin, fat, and/or muscle to cover a wound/defect) is ideal for low-resource settings because it only requires a few simple surgical instruments to perform but effectively treats so many complex yet common issues encountered in LMICs. Therefore, our simulation platform facilitates self-directed learning about the various designs of local flaps (e.g. Z-plasty, rotation-advancement, transposition, etc.), the indications on when to use each of these flaps, how to design/position them relative to the condition that is being treated, and the step-by-step process to performing the surgery. The psycho-motor skills developed in this way will allow the surgeon to successfully perform the precise incisions (i.e. length, angle, orientation), tissue elevation (i.e. dissection of unique tissue planes), mobilization (i.e. rotation, advancement, positioning, tissue handling), and suture-closure or "inset" of the flap. Understanding the planning and psycho-motor skills to execute these flaps is critical to ensuring the survival of the transferred tissues to achieve complete coverage and reconstruction of the wound or defect.

This platform is designed to adapt to surgical trainees at any stage of training. It will be valuable for beginners to experts because each individual can tailor the complexity of the flaps and defects that they practice on the simulation pad. A beginner may practice the basics of drawing out the markings for the flaps, performing the incisions, separating the anatomic layers, delicately handling tissues, and complex suturing techniques for appropriately positioning the flap. With increasing expertise, the type of flap that is designed, the size and shape of the defect, and the missing tissues that need to be reconstructed can all be modified to further challenge trainees as they progress in their understanding of the procedures and their ability to execute the necessary psycho-motor skills for each clinical situation. Our team has three surgical trainees from both the US and Sub-Saharan Africa (SSA) who have completed different levels of general and plastic surgery training. Their experiences associated with the challenges of learning flap surgeries have shaped the design of the simulation pad as well as the virtual learning platform. We are also recruiting additional surgical trainees and surgeons from SSA to provide feedback for further development of the platform.

Our current team composition is as follows:

Team Designations: 
Team Co-Lead: Zach Collier & Priyanka Naidu 
Clinician: Priyanka Naidu (designated SSA representative from Cape Town, South Africa), recruiting additional surgical trainees and surgeons from SSA (Rwanda, Ethiopia)
Educators: Kate Tulenko, Maimunat Alex-Adeomi
Clinical Consultant: John Dutton
Strategists: Ruben Ayala, Libby Durnwald
Regional Liaisons: Morgan Bober, Tamlin Abrahams
Policy: Desmond Jumbam
Technical Experts: Zachary Collier, John Dutton,(seeking others with software engineering and materials engineering backgrounds)

We are looking forward to welcoming new team members with technical expertise related to software engineering, animation, and materials engineering/manufacturing. We have a well-developed team of clinicians and education specialists with the necessary background required to design a relevant and effective training simulation concept, but we need experts who can provide technical assistance with the coding for the virtual learning platform, animation for the surgical videos, and materials engineering for the manufacturing of the simulation pad. As part of Operation Smile, we have extensive experience collaborating with companies that have developed other forms of virtual and physical surgical simulation platforms for cleft lip and palate surgeries, so we are looking forward to using our prior experience to successfully collaborate with Challenge participants who have the necessary skill set and passion to support this endeavor.