Dye-Perfused Human Placenta for Simulation in a Microsurgery Laboratory for Plastic Surgeons

Abstract

In recent decades, a number of simulation models for microsurgical training have been published. The human placenta has received extensive validation in microneurosurgery and is a useful instrument to facilitate learning in microvascular repair techniques as an alternative to using live animals. This study uses a straightforward, step-by-step procedure for instructing the creation of simulators with dynamic flow to characterize the placental vascular tree and assess its relevance for plastic surgery departments. Measurements of the placental vasculature and morphological characterization of 18 placentas were made. After the model was used in a basic microsurgery training laboratory session, a survey was given to nine plastic surgery residents, two microsurgeons, and one hand surgeon. In all divisions, venous diameters were larger than arterial diameters, with minimum diameters of 0.8 and 0.6 mm, respectively. The majority of the participants considered that the model faithfully reproduces a real microsurgical scenario; the consistency of the vessels and their dissection are similar in in vivo tissue. Furthermore, all the participants considered that this model could improve their surgical technique and would propose it for microsurgical training. As some of the model's disadvantages, an abundantly thick adventitia, a thin tunica media, and higher adherence to the underlying tissue were identified. The color-perfused placenta is an excellent tool for microsurgical training in plastic surgery. It can faithfully reproduce a microsurgical scenario, offering an abundance of vasculature with varying sizes similar to tissue in vivo, enhancing technical proficiency, and lowering patient error.

Keywords

microsurgery - plastic surgery - simulated training - placenta - anatomical models

Authors' Contributions

Conceptualization: L.C.Z.-J. and D.F.A.-A.

Methodology: L.C.Z.-J. and D.F.A.-A.

Writing - original draft: L.C.Z.-J., K.D.D.-S., and M.A.R.-S.

Formal analysis: L.C.Z.-J., K.D.D.-S., M.A.R.-S., D.F.A.-A., G.L.M.-F., and M.A.R.-B.

Writing - review & editing: L.C.Z.-J., K.D.D.-S., M.A.R.-S., D.F.A.-A., G.L.M.-F., and M.A.R.-B.

Ethical Approval

The study has the approval of the Ethics and Research Committee of the Hospital Universitario de Santander in the Act No. 08 of June 18, 2021 and of the Universidad Industrial de Santander through CEINCI Act No. 1 of February 5, 2021.

Patient Consent

The authors obtained the informed consent of the 18 patients who allowed the investigation and use of their placentas.

Publication History

Received: 08 February 2023

Accepted: 15 June 2023

Accepted Manuscript online:
20 June 2023

Article published online:
01 November 2023

• References

• 1 Del Maestro M, Rampini AD, Mauramati S. et al. Dye-perfused human placenta for vascular microneurosurgery training: preparation protocol and validation testing. World Neurosurg 2021; 146: e854-e864
• 2 Rodriguez JR, Yañez R, Cifuentes I, Varas J, Dagnino B. Microsurgery workout: a novel simulation training curriculum based on nonliving models. Plast Reconstr Surg 2016; 138 (04) 739e-747e
• 3 Gallardo FC, Bustamante JL, Martin C. et al. Novel simulation model with pulsatile flow system for microvascular training, research, and improving patient surgical outcomes. World Neurosurg 2020; 143: 11-16
• 4 Trignano E, Fallico N, Zingone G, Dessy LA, Campus GV. Microsurgical training with the three-step approach. J Reconstr Microsurg 2017; 33 (02) 87-91
• 5 Oliveira Magaldi M, Nicolato A, Godinho JV. et al. Human placenta aneurysm model for training neurosurgeons in vascular microsurgery. Neurosurgery 2014; 10 (Suppl. 04) 592-600 , discussion 600–601
• 6 Pérez Zabala JZ, Beldi F, Tovar A. et al. Modelo integral de entrenamiento microquirúrgico y neuroendovascular con placenta humana. Rev Argent Neurocir 2020; 34 (04) 300-314
• 7 Belykh E, Lei T, Safavi-Abbasi S. et al. Low-flow and high-flow neurosurgical bypass and anastomosis training models using human and bovine placental vessels: a histological analysis and validation study. J Neurosurg 2016; 125 (04) 915-928
• 8 Fasano D, Montanari FM, Guzzardella GA, Fini M, Nicoli Aldini N, Giardino R. The human placenta: a complementary method for microsurgical training. Eur J Plast Surg 1994; 17 (03) 142-143
• 9 Gómez-Vega JC, Mancera Pérez J, Reghin Neto M, Holanda V, De Oliveira E. Desarrollo de técnicas microquirúrgicas usando tinción vascular con y sin silicona en placenta humana con modelos craneales 3D. Rev Argent Neurocir 2020; 35 (02) 160-171
• 10 Bekov DB. [Nomenclature of blood vessels of the chorion of mature human placenta]. Arkh Anat Gistol Embriol 1991; 100 (06) 96-102
• 11 Bekov DB. Individual'naia anatomicheskaia izmenchivost' arteriĭ plodnoĭ poverkhnosti platsenty cheloveka. Arkh Anat Gistol Embriol 1990; 98 (02) 32-43
• 12 Oliveira MM, Wendling L, Malheiros JA. et al. Human placenta simulator for intracranial-intracranial bypass: vascular anatomy and 5 bypass techniques. World Neurosurg 2018; 119: e694-e702
• 13 Ramírez MA, Contreras DR, Cartes UJ. et al. Entrenamiento microquirúrgico básico para realizar un modelo animal de alotrasplante compuesto vascularizado. Rev Chil Cir 2013; 65 (05) 389-395
• 14 McGregor JC, Wyllie FJ, Grigor KM. Some anatomical observations on the human placenta as applied to microvascular surgical practice. Br J Plast Surg 1983; 36 (03) 387-391
• 15 Romero FR, Fernandes ST, Chaddad-Neto F, Ramos JG, Campos JM, Oliveira Ed. Microsurgical techniques using human placenta. Arq Neuropsiquiatr 2008; 66 (04) 876-878
• 16 Ayoubi S, Ward P, Naik S, Sankaran M. The use of placenta in a microvascular exercise. Neurosurgery 1992; 30 (02) 252-254
• 17 Yonekawa Y, Frick R, Roth P, Taub E, Imhof H-G. Laboratory training in microsurgical techniques and microvascular anastomosis. Oper Tech Neurosurg. 1999; 2 (03) 149-158
• 18 Ribeiro de Oliveira MM, Nicolato A, Santos M. et al. Face, content, and construct validity of human placenta as a haptic training tool in neurointerventional surgery. J Neurosurg 2016; 124 (05) 1238-1244
• 19 Ramírez Barba EJ, Domínguez Garibaldi FJ, Córdova Villalobos JA, García Vázquez JP, Flores Ramírez LA, Muñoz Ramos R. et al. El sso de la placenta en el entrenamiento microquirúrgico. Cir gen 1995; 17 (01) 11-13