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Original Investigation
April 25, 2019

Computer-Aided Design, 3-D–Printed Manufacturing, and Expert Validation of a High-fidelity Facial Flap Surgical Simulator

Author Affiliations
  • 1Medical School, University of Michigan, Ann Arbor
  • 2Otolaryngology–Head and Neck Surgery, Pediatric Division, University of Michigan Health Systems, CS Mott Children’s Hospital, Ann Arbor
  • 3Department of Biomedical Engineering, University of Michigan, Ann Arbor
JAMA Facial Plast Surg. 2019;21(4):327-331. doi:10.1001/jamafacial.2019.0050
Key Points

Question  Can computer-aided design and 3-dimensional printing be leveraged to develop a novel high-fidelity surgical simulator for facial flap simulation?

Findings  Seven expert otolaryngologist–head neck surgeons with fellowship training in facial plastic surgery validated the facial local flap simulator with high evaluations for physical attributes, realism, performance, experience, and value as a simulator.

Meaning  Expert validation suggests that the simulator may be useful for medical education during residency training.


Importance  Facial flap procedures may be difficult for surgical trainees to conceptualize and challenging for supervising surgeons to allow entrustment early in training. Simulation outside of the operating room may accelerate and enhance the surgical education experience.

Objective  To design and manufacture a 3-dimensional (3-D)–printed, multilayer, anatomically accurate facial flap model for use in surgical education.

Design, Setting, and Participants  In this multicenter validation study, a 3-D–printed facial flap simulator was designed from a computed tomographic (CT) scan and manufactured for low-cost, high-fidelity simulation. Expert otolaryngology–head and neck surgeon feedback was acquired through surgical rehearsal and performance of 8 local facial flap procedures on the facial flap simulator by 7 otolaryngologists fellowship trained in facial plastic surgery.

Main Outcomes and Measures  Likert scale surveys were made based on evaluation criteria categorized into domains of realism, experience, and applicability of the simulator. Measures of central tendency, variability, and confidence intervals were generated to evaluate the outcomes.

Results  Seven expert otolaryngology–head and neck surgeons completed a Likert scale evaluation survey containing quantitative analysis of 6 questions on physical attributes, 12 questions on realism, 8 questions on experience, and 4 questions on the applicability of the simulator. All expert surgeons were additionally fellowship trained in facial plastic surgery with their mean years in practice being 11.9. Overall evaluation demonstrated valuable ability of the simulator for medical education with suggestions for future directions. Importantly, the simulator was rated on a scale of 1 (no value) to 4 (great value) as 3.86 as a training tool, 3.57 as a competency evaluation tool, and 3.43 as a rehearsal tool.

Conclusions and Revelance  Expert experience with the local facial flap simulator was rated highly for realism, experience, performance, and usefulness. With slight refinement, the model has strong potential for broad use in training in otolaryngology–head and neck surgery and facial plastic surgery.

Level of Evidence  NA.