Development and Impact of Virtual Reality-Based Training for the Radial Forearm Free Flap: A Multicentre Prospective Feasibility Study

Abstract

Introduction
Surgical education faces growing challenges due to reduced theatre access, variable supervision and limited procedural exposure, particularly for complex reconstructive operations such as the radial forearm free flap (RFFF). Virtual reality (VR) offers an opportunity to deliver immersive, standardised surgical training unconstrained by geography or theatre availability. This study evaluates the effectiveness of a VR-based teaching intervention in improving procedural confidence and anatomical understanding of the RFFF.

Methods
A prospective multicentre feasibility study was conducted across 10 UK medical schools and one NHS trust. Participants completed a 60-minute workshop including a 360° VR simulation of the RFFF procedure and a VR anatomical exploration session. Pre- and post-workshop surveys assessed procedural confidence, anatomical understanding and user experience using validated Likert-scale tools.

Results
141 participants completed both pre- and post-workshop assessments. The majority were undergraduate medical students (90.8%), of whom 93.8% had never previously observed an RFFF. Procedural confidence improved significantly from a median of 2 (IQR 2) to 4 (IQR 1) post-workshop (p < 0.001), with greater improvements in those without prior exposure. Anatomical confidence also increased from 3 (IQR 1) to 4 (IQR 2) (p < 0.001), particularly among pre-clinical medical students. Participants rated the module highly for educational value, immersion and clarity of anatomical and procedural content.

Conclusion
The VRiMS RFFF teaching module significantly improves learner confidence and anatomical understanding, particularly among early-stage trainees. These findings support the use of VR-based platforms as effective and scalable adjuncts to existing surgical education.