ABSTRACT
Facial laceration repair is a common emergency department procedure with important cosmetic implications for patients. In instances where the vermillion border is violated special attention must be paid to accurate opposition, as little as 1 mm of misalignment can result in poor cosmetic results. We sought to construct and evaluate an affordable, effective, and easily reproduced simulation trainer of full-thickness lip laceration requiring vermillion border repair primarily for Emergency Medicine resident education. To accomplish this we utilized microfoam tape, 4x4 gauze, self-adherent wrap, and markers to simulate a multi-layered lip laceration with vermillion border involvement. The microfoam tape with gauze folded on top of itself simulates the orbicularis oris muscle and subcutaneous fat layer. The self-adherent gauze covered by an additional piece of microfoam tape simulates the dermal/epidermal junction. This training model can be attached to an upside-down emesis basin with tape and then trainees can practice appropriate repair techniques. This task trainer was then utilized in our scheduled, simulation didactic sessions with Vanderbilt University Medical Center's Emergency Medicine residents. In total, 23 PGY 1-3 EM residents participate in the session. Nineteen (83%) completed an anonymous reporting survey rating features of the didactic on a five-point Likert scale. Resident comfort level performing the procedure prior to the teaching session was fair (mean 2.53 {SD 1.04}) and afterward significantly higher (mean 4.31 {SD 0.57}) P <0.0001. The task trainer was highly rated (mean 4.74 {SD 0.55}) and the overall didactic was also very highly rated (mean 4.84 {SD 0.50}). The model we have described here can be constructed in minutes from supplies that are readily available in any healthcare setting and was rated by residents to substantially improve procedural confidence in regards to complex lip laceration repair.
ABSTRACT
PURPOSE: This study is conducted to investigate the feasibility of echographic imaging of tissue thickness of healthy and reconstructed cleft lip. DESIGN: Prospective study. MATERIALS AND METHODS: The study was conducted in SDM Craniofacial Unit, Dharwad and was approved by Local Institutional Review Board. A total of 30 patients, age group ranging from 4 to 25 years, of which 15 postoperative unilateral cleft lip constituted the test group. The remaining 15 with no cleft deformities, no gross facial asymmetry, constituted the control group. The thickness of the mucosa, submucosa, muscle and full thickness of the upper lip were measured with the transversal images using ultrasonography at midpoint of philtrum, right and left side philtral ridges and vermillion border, at 1, 3, 6 months interval. RESULTS: There was an increase in muscle thickness at the vermillion border (mean = 6.9 mm) and philtral ridge (5.9 mm). Equal muscle thickness were found between the normal and test group at 6 months follow-up in a relaxed position, which was statistically significant (P = 0.0404). CONCLUSION: Quantitative assessment of thickness and echo levels of various lip tissues are done with proper echographic calibration. Diagnostic potentials of this method for noninvasive evaluation of cleft lip reconstructions were achieved by this study.