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Surgical training has undergone a rapid transformation over the last decade. One outcome of these changes is the interest that has been generated in the possibility of training surgical skills outside the operating theatre. We describe a cost-effective tool that may be used to improve surgical handling and improve surgical concepts in facial plastic surgery.
The skills obtained from these simulators may then be transferred to the operative environment. Although simulation models require further validation before they can be used as an assessment tool for means of appraisal and revalidation, their use in teaching and training is increasingly being realised. We have developed a cost-effective surgical simulator model for teaching and training facial plastic surgeons.
1. Methods
We have used a mannequin head and covered it with a chamois cloth. The chamois cloth can be pinned in position to cover the mannequin, stimulating the skin on the face (Fig. 1, Fig. 2) . This model costs less than £5. Skin lesions may be marked and trainees asked to discuss the surgical options and margins for a variety of different pathologies. In Fig. 3 the surgical excision margins for a basal cell carcinoma (BCC) have been drawn around the lesion. Local flaps may be discussed and trainees allowed to practice using their design (Fig. 3, Fig. 4) . The careful use of a water spray allows the chamois leather to stretch.
Fig. 1Equipment required to construct the surgical model.
Scars may be marked on the face and the trainee asked to mark a suitable means of revising the scar, allowing suitable training and understanding of Z plasty design.
2. Discussion
Surgeons are assessed while they are training for their knowledge, decision-making and dexterity. Simulators may provide training in all these areas providing many advantages. Training and practice can take place in an environment free of significant risk to other trainee or patient. Its activity can be replicated as many times as necessary and practice can be interrupted when necessary and recommenced as appropriate. The degree of difficulty can be readily adjusted to meet the individual learner's needs and opportunities are always available for practice, without having to wait for an appropriate case. Reliable feedback can be provided for the instructor and student instantaneously and it removes the ethical dilemmas associated with other forms of surgical training.
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