A vascularized emergency trauma amputation simulator for surgical skills training

Background: We describe the development of a low-cost lower-extremity amputation model enhanced with simulated pulsatile vasculature (SPV). The vascularized emergency trauma amputation simulator (VETAS) permits students to practice clinical decision-making, prepping and draping, hemostatic knot-tying, and lower-extremity amputation. SPV was achieved using a microcontroller, regulating the flow of artificial blood through a bypass flow system, preventing excessive pressure when the SPV is clamped. The SPV system replicates a pulse of 75 beats/min, a pressure of 120/80 mmHg, and a flow rate of 350 mL/min. We assessed if the model and simulation scenario accomplished our design goals of cost-effective, multidimensional education, with efficient turnover between learners. Methods: A low-cost VETAS was engineered to simulate the tibia and tibial artery using SPV. A simulation scenario was prepared for medical students’ training. A preand post-training survey was completed by 53 attendees to evaluate the experience. Survey responses were ranked using a Likert scale and analyzed using a Wilcoxon signed-rank test. Results: The VETAS was constructed with inexpensive, readily available materials. The technology allows for efficient, reproducible training. Post-training survey analysis demonstrated statistically significant increases in familiarity with creating a sterile surgical field and with proper instrument handling (P50.001). An increased sense of confidence regarding lowerextremity surgical anatomy was also confirmed (P50.014). Conclusion: The VETAS model successfully introduced medical students to the principles of emergency trauma surgery. This novel technology created a cost-effective platform for efficient and effective skills training.