Hand Surgery and the Web for Plastic Surgery Training

Abstract

The proliferation of mobile devices (iPhone, iPad, etc), cloud-based resources, and mobile apps has expanded the availability and utility of electronic resources for surgical training.1–3 Specifically, in the field of plastic surgery, numerous mobile software applications (“apps”) and web sites now have the potential to enhance education beyond the obvious limitations of traditional medical books and journals.4,5 This presentation highlights the most innovative technology available for plastic surgery residents. The earliest integration of mobile apps into education began with electronic versions of traditional textbooks and journals. The benefits of digital books include mobility, accessibility, and search capabilities. For example, a single iPad with only a few gigabytes of memory stores multiple volumes of surgical textbooks and thousands of articles. Portable document format management apps, such as iAnnotate, GoodReader, and Papers, enhance reading via a wealth of features, such as annotation, editing, and integration with cloud storage services, such as DropBox or Google Drive. Many mobile apps also provide a quick reference for pathologic conditions, surgical techniques, or anatomy. AO Surgery Reference is a popular and free app among orthopedic and plastic surgery residents for the management of extremity and head/neck fractures. The app includes detailed information about treatment options, surgical approaches, tips/tricks during the procedure, and recommendations for implant and fixation options. Ortho Traumapedia is another popular app that utilizes an easy-to-navigate list of fractures and dislocations separated into sections titled “facts,” “images,” “classify,” and “treat.” The app includes bullet points about each injury, annotated radiographs to help the trainee recognize relevant imaging findings, popular classification systems with associated diagrams, and treatment principles. A new app that encourages user interaction is called Touch Surgery. Impressively, the app is free and offers an extraordinary number of surgical procedure tutorials. The teaching format requires the user to perform actions (“select the knife,” “make the incision,” etc) by swiping a finger across the screen, presumably enhancing learning via tactile feedback. Lessons include both teaching as well as testing modules, allowing trainees to check their comprehension and understanding of a procedure. Another innovative app is Complete Anatomy, which offers a blank canvas for surgical tutorials in the form of a 3D human body that can be manipulated, annotated, rotated, and explored. The editing features provide unmatched potential for anatomic learning, surgical lessons, and virtual dissection. For example, users can create lessons by disappearing layers or making body parts fade away, permitting a view of underlying structures. The app also includes 3D drawing tools, such as pens, arrows, or even the ability to add fractures, arthritis, or pain to an image. Lessons can be recorded and shared with others to convey specific teaching points. Clearly, the potential for technologically based enhancement in surgical education outpaces our ability to change teaching trajectories and curricula. However, it remains our responsibility to intermittently reevaluate our teaching methods and consider new tools for educating our students and residents.