Isolated Lower Extremity Specimens Enhance Efficiency and Cost-Effectiveness in Cadaveric Flap Dissection Training for Clinical Practice-Chang Gung Experience.

Abstract

Conventional microsurgical flap dissection courses typically utilize whole-body cadavers and emphasize the advantage of exposing participants to a greater number of flap dissections within a single course. However, we hold a different perspective. Although this viewpoint has been expressed in various courses and academic forums, it has not generated substantial discussion or adoption. We believe the issue is largely conceptual and psychological. Many participants appear to embrace the notion that "the more flaps learned, the better," and course organizers often respond accordingly by promoting the opportunity to learn as many flaps as possible in one setting. In reality, this approach may overlook a fundamental principle: the essence of microsurgical flap training lies in mastering the core techniques of flap dissection-skills that are transferable across virtually all flap harvest procedures. With this philosophy in mind, the Chang Gung Microsurgery Center initiated an annual cadaveric dissection course using isolated lower extremity specimens soon after the establishment of the hospital's skill laboratory and dedicated cadaveric dissection facilities. In this narrative review, we describe the conceptual framework derived from our high clinical case volume and long-standing surgical education philosophy, together with our unique institutional experience and resources. The curriculum focuses primarily on three "mother" flaps that serve as both technical foundations and clinical workhorses-the anterolateral thigh flap, the fibular osteoseptocutaneous flap, and the toe flap-supplemented by other flaps that can be harvested from the lower extremity. We also discuss the transferability of these techniques to other reconstructive applications. Furthermore, we outline how our institution's distinctive resources are integrated to provide participants with a comprehensive understanding of microsurgical practice. The advantages of this lower extremity-focused training model-including improved learning efficiency and reduced financial and administrative burdens for both organizers and participants-are examined. We hope this model may serve as a valuable reference for medical centers currently engaged in, or planning to develop, microsurgical education and training programs.