A Cost-Effective, Three-Dimensionally Printed Simulation Model Facilitates Learning of Bilobed and Banner Flaps for Mohs Nasal Reconstruction: A Pilot Study

Flap design for Mohs reconstruction is a complex 3-dimensional process. Simulation offers trainees the chance to practice techniques safely before performing them in the operating room. To aid in teaching, the authors developed a high-fidelity, cost-effective model of the face using three-dimensional printing to simulate flap reconstruction after Mohs surgery. A model face was sculpted digitally to include skin, bone, and cartilage. Negative molds were printed and used to cast silicone, representing external skin. The cartilage and bone models were combined to create a single three-dimensionally printed base. Surgical residents practiced performing banner and bilobed flaps on the simulation model, and improvement was assessed using boards-style pretests and posttests assessing flap design on clinical photographs. Medical students were randomized to complete a similar practice session with the model or a reading on the topic, after which they completed the same assessment. Participants also completed a questionnaire about the model's didactic and monetary value. Residents showed significant improvement after use of the model (banner flap: P = 0.002, bilobed flap: P = 0.04). Medical students who used the model scored significantly higher than those assigned to train by reading (P = 0.001). Subjective comfort with flap design and execution increased after practice with the model (P = 0.001). The cost of materials for each model was $2.50; participants reported willingness to pay $24.36 (mean) for this tool. This accessible model was superior to traditional teaching materials for Mohs reconstruction, and aided the comfort and proficiency of trainees.