Beef Tongue Model, a practical alternative for teaching the repair of obstetric anal sphincter laceration. Obstetrical anal sphincter injuries occur in 2 to 19% of vaginal births. Despite primary repair, up to 50% of women experience some degree of fecal incontinence after anal sphincter repair. The decreased incidence of forceps deliveries and episiotomy has limited exposure to anal sphincter injuries in training. According to recent data, 60% of residents report no didactic teaching on episiotomy repair and were supervised only 1 out of 3 times. Several models have been proposed to assist with training residents in repair of obstetric anal sphincter lacerations. Training on commercial replicas is costly, not readily available, or laborious to assemble. This video will demonstrate how to assemble this cost-effective and practical model to simulate repair of 3rd and 4th degree lacerations. Beef Tongue can be purchased in most meat departments at a cost of $4.99 per pound. Each tongue will make about 4 to 5 models. Vinyl PVC tubing is used to represent the rectum in the model. This tubing is cut into 3 to 4 inch segments. Foam backer rod is used to represent the lacerated edges of the external anal sphincter. The backer rod is cut into 2 to 3 inch segments. Heavy shears are useful for cutting the vinyl PVC tubing. Needle nose pliers are helpful for guiding the vinyl tubing and the backer rod through the length of the beef tongue. T-handle reamer is used to create tunnels for the vinyl tubing and backer rod. Lastly, we use a chef's knife to make incisions on the tongue. The initial total cost of making 4 models would be approximately $57, which includes a one-time cost of tools. Each additional model will cost on average $3 to $4 per model. Begin with a partially thawed beef tongue. There is a ventral and a dorsal surface to the tongue. Use a chef's knife to trim off the ventral surface of the tongue. Cut the beef tongue into 3 to 4 inch segments. Use the T-handle reamer to create a lengthwise tunnel through the beef tongue. Use the needle nose pliers to guide a 3 inch segment of vinyl tubing through the tunnel. This will represent the rectum. Make a lengthwise cut with a knife to represent the vaginal laceration. Again, using the T-handle reamer, create bilateral diagonal tunnels within the perineal laceration at 5 o'clock and 7 o'clock. Use the needle nose pliers to pull a 3 inch segment of foam backer rod through each tunnel. This will represent the lacerated edges of the external anal sphincter. Use the knife to make lengthwise cuts just deep to the initial cut. This will represent the internal anal sphincter. We will now demonstrate how to simulate an anal sphincter repair on the beef tongue model. Approximate the rectal mucosa in a running fashion. Shown here is closure with 2-O Vicryl. Note, we performed this step just superficial to the rectal mucosa on the beef tongue model as the vinyl tubing is too rigid to sew through. The vinyl tube is removed and a finger is placed in the rectum. The internal anal sphincter is placated using 2-O PDS suture in an interrupted fashion. A fundamental step of this placation is to reach down into the groove to retrieve the edges of the internal anal sphincter. A total of 3 sutures are placed. The lacerated edges of the external anal sphincter are now re-approximated. Shown here, we place 3 interrupted stitches in the internal anal sphincter. The lacerated edges of the external anal sphincter are now re-approximated. Shown here, we place 3 interrupted stitches of 2-O PDS using an end-to-end technique. Alternatively, an overlapping technique can be used on the model. Next, repair the rectovaginal septum using interrupted stitches of 0-Vigral. In our experience, an interrupted technique allows the suture to be placed in the correct position. In our experience, an interrupted technique allows the learner to more closely re-approximate the edges of the laceration. The last stitch shown here represents the re-approximation of the bulbocavernosis muscle and the superficial transverse peroneal muscle. The peroneal repair is performed with interrupted stitches of 0-Vigral. The peroneal repair is performed with interrupted stitches of 0-Vigral. The peroneal repair is performed with interrupted stitches of 0-Vigral. The peroneal repair is performed with interrupted stitches of 0-Vigral. Alternatively, the peroneum can be closed with a running stitch of monofilament suture. Alternatively, the peroneal can be closed with a running stitch of monofilament suture. Finally, close the vaginal epithelium with a running stitch. Finally, close the vaginal epithelium with a running stitch. Finally, close the vaginal epithelium with a running stitch. Finally, close the vaginal epithelium with a running stitch. Finally, close the vaginal epithelium with a running stitch. Finally, close the vaginal epithelium with a running stitch. Shown here is a 2-0-Vigral stitch. The Beef Tongue model is a practical, cost-effective, and easy-to-assemble tool that engages residents in active learning. It includes all the key steps of OASIS repair. The model can be incorporated into formal teaching of obstetric laceration repair in an effort to address this deficiency in residency training. We anticipate that increased exposure to these complex repairs could improve patient outcomes following anal sphincter injuries.

obstetric anal sphincter lacerations

repair simulation

vinyl PVC tubing

foam backer rod

T-handle reamer