(PI-014) Testing of a Novel Plantar Ulcer Debridement Surgical Model

Christina Jensen, DNP, MSN, ANP-BC, APNP, CWS – Nurse Practitioner, General Internal Medicine, Medical College of Wisconsin; Michael Malinowski, MD, MEHP, FACS, RPVI – Associate Professor, Surgery, Medical College of Wisconsin

Introduction:

Diabetic and neuropathic foot ulcers are common, and serious, leading to amputations if not properly managed.  Debridement is a critical part of wound bed preparation but learning the debridement of these ulcers is challenging.  It would be a standard teaching method to practice with simulation models before operating on live patients with neuropathic ulcers.  However, commercial models that can simulate the neuropathic foot ulcer are not readily available, and oranges are commonly used. To our knowledge no models have been tested for efficacy with learners.  We developed and tested a novel simulation model for teaching new learners how to debride neuropathic pressure ulcers on the foot. 

Methods:

A model was developed with a basic plantar surface made from 1cm thick polyurethane polymer for this proof-of-concept phase.  Each foot model holds the round debriding cartridge (1.25” diameter, 0.25” thick), containing a two-layer silicone filling, with a hole in the middle simulating the ulcer.  The hardness of the top layer is consistent with callous density and is colored like callous tissue.  A deeper layer of red silicon signifies viable non-necrotic tissue and therefore is the deepest extent layer of debridement needed in the model.  Testing was done at the national meeting of the American College of Physicians, where wound debridement is taught at the Clinical Skills Workshop on chronic wound care.  Forty-one consecutive physicians underwent the training and later gave their anonymous feedback. 

Results:

Three quarters of the participants had minimal or no prior experience.  The overwhelming majority (95%) felt their understanding was moderately or substantially improved. Most participants (76%) felt the two-color model helped substantially in understanding the extent of debridement needed. Eighty percent felt strongly that the model was appropriate for their skill level.

Discussion:

A novel neuropathic foot ulcer debridement model is well received by learners who are new to this skill and raises their confidence for future debridement. 

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