The Chicken Thigh Adductor Profundus Free Muscle Flap: A Novel Validated Non-Living Microsurgery Simulation Training Model.

BACKGROUND: Simulation training is becoming an increasingly important component of skills acquisition in surgical specialties, including Plastic Surgery. Non-living simulation models have an established place in Plastic Surgical microsurgery training, and support the principles of replacement, reduction and refinement of animal use. A more sophisticated version of the basic chicken thigh microsurgery model has been developed to include dissection of a type 1-muscle flap and is described and validated here. METHODS: A step-by-step dissection guide on how to perform the chicken thigh adductor profundus free muscle flap is demonstrated. Forty trainees performed the novel simulation muscle flap on the last day of a 5-day microsurgery course. Pre- and post-course microvascular anastomosis assessment, along with micro dissection and end product (anastomosis lapse index) assessment, demonstrated skills acquisition. RESULTS: The average time to dissect the flap by novice trainees was 82±24 minutes, by core trainees 90±24 minutes, and by higher trainees 64±21 minutes (P=0.013). There was a statistically significant difference in the time to complete the anastomosis between the three levels of training (P=0.001) and there was a significant decrease in the time taken to perform the anastomosis following course completion (P<0.001). Anastomosis lapse index scores improved for all cohorts with post-test average anastomosis lapse index score of 3±1.4 (P<0.001). CONCLUSIONS: The novel chicken thigh adductor profundus free muscle flap model demonstrates face and construct validity for the introduction of the principles of free tissue transfer. The low cost, constant, and reproducible anatomy makes this simulation model a recommended addition to any microsurgical training curriculum

Aerosol analysis and forecast in the European Centre for Medium-Range Weather Forecasts Integrated Forecast System: Forward modeling

International audienceThis paper presents the aerosol modeling now part of the ECMWF Integrated Forecasting System (IFS). It includes new prognostic variables for the mass of sea salt, dust, organic matter and black carbon, and sulphate aerosols, interactive with both the dynamics and the physics of the model. It details the various parameterizations used in the IFS to account for the presence of tropospheric aerosols. Details are given of the various formulations and data sets for the sources of the different aerosols and of the parameterizations describing their sinks. Comparisons of monthly mean and daily aerosol quantities like optical depths against satellite and surface observations are presented. The capability of the forecast model to simulate aerosol events is illustrated through comparisons of dust plume events. The ECMWF IFS provides a good description of the horizontal distribution and temporal variability of the main aerosol types. The forecastonly model described here generally gives the total aerosol optical depth within 0.12 of the relevant observations and can therefore provide the background trajectory information for the aerosol assimilation system described in part 2 of this paper