Perforator Dissection Simulation: A High-Fidelity Five-Flap Porcine Training Model



Perforator dissection can be technically demanding with a steep learning curve. Inadvertent perforator damage during dissection can be minimized with practice and familiarity with tissue-handling techniques unique to perforator dissection. There currently lacks a simulation model that mimics the human perforator in size and course. We present a porcine training model with five consistent perforator flaps per side that can be readily harvested and is a reproducible simulation model.

Materials and Methods

Five fresh cadaveric pigs were used in this study to evaluate the feasibility and location of the perforators. Ten perforators were dissected out in each pig (five per side) by the same surgeon. The length of perforator was measured and intramuscular route was noted. The ease of dissection was graded, and its similarity to actual surgery was graded as well.


Five consistent perforators were identified across each side of five fresh cadaveric pigs. The perforators were located, namely in the neck, anterior flank, posterior flank, rectus and hindlimb. They were fasciocutaneous and had an intramuscular course of each (average 2.5 cm length). The perforators were found to be on each side of the pig, giving ten perforators for dissection practice in total.


The five perforators named in this porcine model are easily replicated and can be performed for perforator dissection simulation and practice.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6


  1. 1.

    de Blacam C, Tierney S, Shelley O (2017) Experience of plastic surgery registrars in a European Working Time Directive compliant rota. J Plast Surg Hand Surg. 51(4):264–269

    Article  Google Scholar 

  2. 2.

    Loh CY, Tiong VT, Loh AY, Athanassopoulos T (2014) Microsurgery training: a home do-it-yourself model. Microsurgery 34(5):417–418

    Article  Google Scholar 

  3. 3.

    Dumestre D, Yeung JK, Temple-Oberle C (2014) Evidence-based microsurgical skill-acquisition series part 1: validated microsurgical models—a systematic review. J Surg Educ 71(3):329–338

    Article  Google Scholar 

  4. 4.

    Loh CY, Tiong VT, Loh AY, Athanassopoulos T (2014) Microsurgery training: a home do-it-yourself model. Microsurgery 34(5):417–418

    Article  Google Scholar 

  5. 5.

    Athanassopoulos T, Loh CY (2015) The chicken foot digital replant training model. Hand Surg 20(1):199–200

    Article  Google Scholar 

  6. 6.

    Loh CY, Gunn E, Pennell DJ, Athanassopoulos T (2014) Pinnaplasty: a porcine training model. J Plast Reconstr Aesthet Surg 67(6):868–869

    Article  Google Scholar 

  7. 7.

    Hong JW, Kim YS, Lee WJ, Hong HJ, Roh TS, Song SY (2010) Evaluation of the efficacy of microsurgical practice through time factor added protocol: microsurgical training using nonvital material. J Craniofac Surg 21(3):876–881

    Article  Google Scholar 

  8. 8.

    Stefanidis D, Yonce TC, Green JM, Coker AP (2013) Cadavers versus pigs: which are better for procedural training of surgery residents outside the OR? Surgery 154(1):34–37

    Article  Google Scholar 

  9. 9.

    Tan SS, Sarker SK (2011) Simulation in surgery: a review. Scott Med J 56:104–109

    Article  Google Scholar 

  10. 10.

    Loh CYY, Wang AYL, Tiong VTY, Athanassopoulos T, Loh M, Lim P, Kao HK (2018) Animal models in plastic and reconstructive surgery simulation-a review. J Surg Res 221:232–245

    Article  Google Scholar 

Download references

Author information




YO, CYYL, NP, ML were involved in data collection, drafting of the manuscript and analysis of data; YO, CYYL, NP, ML were responsible for the second review of data, statistical analysis, ensuring data fidelity and manuscript review.

Corresponding author

Correspondence to Yildirim Oezdogan.

Ethics declarations

Conflict of interest

The authors have declared that no conflict of interest exists.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Oezdogan, Y., Loh, C.Y.Y., Prochnow, N. et al. Perforator Dissection Simulation: A High-Fidelity Five-Flap Porcine Training Model. J. Maxillofac. Oral Surg. 19, 151–156 (2020).

Download citation


  • Flap surgery
  • Porcine perforator flap dissection
  • Pig model
  • Plastic surgery
  • Flap
  • Surgical simulation