Simulation of plastic surgery and microvascular procedures using perfused fresh human cadavers * Joseph N. Carey a, *, Elizabeth Rommer a , Clifford Sheckter a , Michael Minneti b , Peep Talving c , Alex K. Wong a , Warren Garner a , Mark M. Urata a a Division of Plastic & Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA b Surgical Skills Simulation & Education Center, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA c Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA Received 6 May 2013; accepted 13 September 2013 KEYWORDS Surgical simulation; Surgical education; Microsurgery; Fresh tissue dissection; Resident education; Resident work hour restrictions Summary Introduction: Surgical simulation models are often limited by their lack of fidelity, which hinders their essential purpose, making a better surgeon. Fresh cadaveric tissue is a su- perior model of simulation owing to its approximation of live tissue. One major unresolved dif- ference between dead and live tissue is perfusion. Here, we propose a means of enhancing the fidelity of cadaveric simulation through the development of a perfused cadaveric model whereby simulation is further able to approach life-like surgery and teach one of the more technically demanding skills of plastic surgery: microsurgery. Method: Fresh tissue human cadavers were procured according to university protocol. Perfu- sion was performed via cannulation of large vessels, and arterial and venous pressure was maintained by centrifugal circulation. Skin perfusion was evaluated with incisions in the perfused regions and was evaluated using indocyanine green angiography. Surgical simulations were selected to broadly evaluate applicability to plastic surgical education. Result: Surgical simulation of 38 procedures ranging in complexity from skin excisions to micro- surgical cases was performed with high priority given to the accurate simulation of clinical pro- cedures. Flap dissections included perforator flaps, muscle flaps, and fasciocutaneous flaps. Effective perfusion was noted with ICG angiography and notable bleeding vessels. * Presentations: Presented at The Plastic Surgery Research Council 57th Annual Meeting, June 14, 2012, Ann Arbor, Michigan. * Corresponding author. Division of Plastic & Reconstructive Surgery, Fresh Tissue Dissection Laboratory, Keck School of Medicine of the University of Southern California, 1510 San Pablo Street, Suite 415, Los Angeles, CA 90033, USA. E-mail address: Joseph.Carey@med.usc.edu (J.N. Carey). 1748-6815/$ - see front matter ª 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.bjps.2013.09.026 Journal of Plastic, Reconstructive & Aesthetic Surgery (2014) 67, e42ee48