TissueDB/Simulators/Z-Plasty Simulator
The Z-Plasty Simulator is a low-cost training platform, built from widely available household and craft materials, for practising Z-plasty and V-Y advancement local-flap reconstructive techniques on a layered tissue analogue representing epidermis, dermis, subcutaneous tissue, and fascia.[1] The trainee performs flap design, elevation, transposition, and inset using a marking pen, scalpel, forceps, hemostat, and needle driver. The AmoSmile team documents two build variants: one uses gelatin-glycerine recipes to form the anatomic tissue layers; the other uses foam-fabric layers on a wood-block base with rubber-band tensioning. The same platform supports a range of local flap surgeries without modification. The original build documentation lives at the AmoSmile Physical Simulator page on Appropedia.
| Field | Details |
|---|---|
| Features and Basic Operation | The trainee can practise the full local-flap sequence on the layered analogue — flap design and marking, incision through the skin and subcutaneous layers, flap elevation in the subcutaneous plane, transposition, inset, and closure. The single platform supports Z-plasty, V-Y advancement, and other local flaps without modification. The build needs no specialized tools or skills — just a hammer or screwdriver and glue for the felt-fabric variant, plus a microwave for the gelatin recipes. An optional companion smartphone app (AmoSmile) offers guided steps and self-assessment; the assembled simulator needs neither electricity nor internet to use. |
| Current Development Status | Built by the AmoSmile programme; volunteers in South Africa, Cameroon, and Rwanda confirmed the low build cost in the field; no formal validity study reported. |
| Estimated Build Time and Cost | $5 |
| Specialized Tools and Equipment | None |
| Version | Version 1 |
| Development Team Contact Information | AmoSmile / Amodisc programme (amodisc.com). |
Tissues
| Tissue | Qty | Material | Cost | Notes |
|---|---|---|---|---|
| New Tissue Simulator Variant (gelatin-glycerine recipes) | ||||
| Muscle | 1 unit | Gelatin:Glycerine:Water (8:8:2), red food colouring, wool substrate | — | Microwave 30 sec. Baste until jam consistency. Wool fibres provide structural matrix. |
| Subcutaneous fat | 1–multiple layers | Gelatin:Glycerine:Water (2:6:12), yellow food colouring, wool substrate | — | Set time 1 hour. Multiple layers glued together with connective tissue paste for thickness. |
| Connective tissue | As needed | Gelatin:Glycerine:Water (5:2:10), no colouring, no substrate | — | Used as adhesive paste between tissue layers. |
| Skin (epidermis + dermis) | 1 unit | Gelatin:Glycerine:Water (10:4:20), pink/white/yellow food colouring, 15 denier stockings substrate | — | Set time 1 hour. Colour amounts vary by desired skin tone. |
| Traditional Felt Simulator Variant (foam fabric layers) | ||||
| Skin (epidermis + dermis) | 2 pieces (12 cm × 12 cm × 2 mm) | Foam fabric | — | Two different colours to distinguish dermis and epidermis layers. Elasticity should match webbing between thumb and index finger. |
| Fascia | 1 piece (12 cm × 12 cm × 2 mm) | Foam fabric | — | Additional foam layer representing the fascial plane beneath soft tissue. |
| Subcutaneous soft tissue | 1–2 sheets (12 cm × 12 cm) | Cotton Batting | — | Placed between skin layers and fascia layer. Represents the soft tissue requiring dissection above the fascia prior to flap opposition. Cotton cleaning pads are a suitable source. |
Structural Parts
| Part Name | Qty | Material | Cost | Notes |
|---|---|---|---|---|
| Base Platform (Traditional Felt Variant) | ||||
| Wood block (foundation) | 1 | Wood | — | Foundation for the platform; thick enough to hold the screws or nails (size given in the build steps). |
| Fasteners (pegs) | 10 (5 per opposing sides) | Screws, nails, or thumbtacks | — | Pegs that hold the rubber bands; equally spaced and aligned with the fasteners on the opposite side. |
| Cardboard tube | 1 | Cardboard cylinder | — | Creates a curved surface to enhance flap simulation. Sources: toilet paper, gift wrapping, textile, or paper towel rolls. |
| Tensioning bands | 6 | Rubber bands or elastic string | — | Secures the soft-tissue construct to the pegs under symmetric tension. |
| Adhesive | As needed | Glue or tape | — | Secures the cardboard tube to the wood block and holds the anatomic layers together. |
Build Instructions
Variant 1: New Tissue Simulator — Tissue Recipe Preparation
Please check out the instructions on new techniques for developing realistic tissue-like simulators.
The AmoSmile team have further developed high-fidelity, low-cost physical simulators to more closely replicate real tissue.[1] Detailed assembly is demonstrated in the new tissue simulator assembly videos.
Muscle
Step 1. Fill ½ mug of water (20 teaspoons).
Step 2. Mix in gelatin, glycerine, and red food colouring (ratio 8:8:2).
Step 3. Mix in 1–2 handfuls of wool. Mix thoroughly so all fibres are soaked.
Step 4. Microwave for 30 seconds.
Step 5. Mix thoroughly again (keeping wool immersed). Wait 20 minutes.
Step 6. Lay on tray. Baste any excess fluid over the laid-out wool, periodically turning the muscle over to ensure an even consistency. Continue basting until it has the consistency of jam. Add to the physical model, continuing to baste until jelly-like.
Fat
Step 1. Mix gelatin, glycerine, water (ratio 2:6:12), and yellow food colouring thoroughly.
Step 2. Add in some wool, teasing it out as you add it. Mix thoroughly.
Step 3. Microwave for 30 seconds. Mix again.
Step 4. Lay on a foil tray, teasing it out to a thin layer. Allow to set for 1 hour.
Step 5. If a thick layer of fat is needed, make multiple layers then glue them together with the connective tissue paste.
Connective Tissue Paste
Step 1. Mix gelatin, glycerine, water (ratio 5:2:10) in a bowl.
Step 2. Microwave for 30 seconds. Wait 5 minutes.
Step 3. Paste between tissue layers.
Skin
Step 1. Mix gelatin, glycerine, water (ratio 10:4:20) and pink, white, and yellow food colouring (adjust amounts according to desired skin tone) in a bowl.
Step 2. Microwave for 30 seconds.
Step 3. Spread a cut stocking (15 denier) out on a foil tray as a single layer.
Step 4. Pour the mixture over the stocking. Turn the stocking over 2–3 times so that it is evenly soaked.
Step 5. Leave aside to set for 1 hour.
Variant 2: Traditional Felt Simulator — Platform Assembly
Assembly video: Watch the step-by-step assembly guide — walks through the process of assembling the physical simulator for the Z-Plasty & V-Y Advancement modules with alternative options for different parts of the build depending on available resources.
Step 1. Use a screwdriver to screw 10 total screws (5 per opposing sides, equally spaced, and aligned with a screw from the opposite side) into the 15 cm × 15 cm wood block. Alternatively, nails, tacks, or pegs can be used.
Step 2. Take a 12–15 cm length cardboard tube or cylinder, cut it in half lengthwise with scissors, and secure it to the wooden block with glue or tape.
Step 3. Glue 2 different-colour 12 cm × 12 cm foam fabric sheets together to represent the dermis and epidermis layers of skin.
Step 4. (Optional) Lines separated by 1 inch (2.5 cm) can be placed on the skin layer to allow feedback on angles and flap reconstruction.
Step 5. Glue a 12 cm × 12 cm piece of layered cotton fabric on top of an additional 12 cm × 12 cm layer of foam fabric representing the fascial layer. The cotton pad represents the soft tissue layer requiring dissection above the fascia prior to flap opposition.
Step 6. Complete the sandwich of fabrics by gluing the top 2 layers of foam fabric (dermis and epidermis) on top of the layered cotton material. The layers represent the dermis, epidermis, soft tissue, and fascia.
Step 7. Create 6 holes in the cut fabric square (3 per opposing sides) using a hole punch or any suitable tool.
Step 8. Ensure the 3 holes on each side align with the 3 holes from the other side so that the rubber bands hold symmetric tension on the fabric.
Step 9. Thread a single rubber band or elastic string through each hole and secure the other end of the elastic band to the corresponding nail or screw.
References
- AmoSmile team: AmoSmile Physical Simulator (Appropedia)
- Assembly video: Z-Plasty & V-Y Advancement Physical Simulator Assembly Guide
- New tissue techniques: New tissue simulator assembly instructions
- ↑ 1.0 1.1 AmoSmile Physical Simulator. AmoSmile team, Appropedia.
| Alternative names | AmoSmile Physical Simulator Local Flap Surgery Simulator V-Y Advancement Simulator AmoSmile Flap Surgery Simulator Z-Plasty Flap Trainer V-Y Advancement Flap Trainer |
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| Authors | |
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| License | CC-BY-SA-4.0 |
| Cite as | "TissueDB/Simulators/Z-Plasty Simulator". Appropedia. 2026. Retrieved July 14, 2026. |