Buried SuturePerforming a two layer wound closure can be a challenging procedure in the Emergency Department for clinicians with limited wound care experience. Challenges include suture choice, suture placement, and the technique of burying the knot in the deep layer of the wound, and the availability of ready ‘volunteers’ with complex wounds willing to let novices practice on them. Commercially available suture models are expensive, and can be cumbersome to store, and difficult to obtain in a timely manner to provide the learner with opportunities to practice prior to wound repair on a patient in the department.

Materials

materials

  • 4 inch white foam tape, 3M microfoam 4” x 5.5 feet ($12-15 per roll)
  • 2 inch ace wrap
  • 4×4 gauze
  • Red marker
  • Emesis basin or other base to attach trainer to

How to build

Step 1. Lay one unfolded piece of 4x4 gauze on the emesis basin.

Step 1. Lay one unfolded piece of 4×4 gauze on the emesis basin.

Step 2. Fold 1-2 cm of the foam tape over itself to create the edge of the fascia.

Step 2. Fold 1-2 cm of the foam tape over itself to create the edge of the fascia.

Step 3. Arrange 2 pieces of folded foam tape over the gauze, leaving a small space between the 2 pieces.

Step 3. Arrange 2 pieces of folded foam tape over the gauze, leaving a small space between the 2 pieces.

Step 4. Color the edge of the fascia, and the gauze at the base of the wound with the red magic marker.

Step 4. Color the edge of the fascia, and the gauze at the base of the wound with the red magic marker.

Step 5. Cut the 2 inch ace wrap longitudinally. Arrange the free edge of the ace wrap along the wound edge. This will form the sub-cuticular structures, and prevent the skin layer from adhering to the fascial layer.

Step 5. Cut the 2 inch ace wrap longitudinally. Arrange the free edge of the ace wrap along the wound edge. This will form the sub-cuticular structures, and prevent the skin layer from adhering to the fascial layer.

Step 6. Place a layer of white foam tape along each side of the wound. This will be the skin layer. The edges of the wound can be secured with tape to prevent them from lifting off the base. In the end, the layers from deep to superficial are: gauze, folded foam tape, ace wrap, and single layer of foam tape.

Step 6. Place a layer of white foam tape along each side of the wound. This will be the skin layer. The edges of the wound can be secured with tape to prevent them from lifting off the base. In the end, the layers from deep to superficial are: gauze, folded foam tape, ace wrap, and single layer of foam tape.

Step 7. For added realism, paint the skin layer with Betadine, and apply a fenestrated drape.

Step 7. For added realism, paint the skin layer with Betadine, and apply a fenestrated drape.

When the model is assembled on the bottom of a 7 quart emesis basin it provides approximately 20 cm of ‘wound’ to suture.

When the model is assembled on the bottom of a 7 quart emesis basin it provides approximately 20 cm of ‘wound’ to suture.

Rob Bryant MD

Rob Bryant MD

Utah Emergency Physicians
Adjunct Assistant Clinical Professor of Emergency Medicine
Division of Emergency Medicine, Department of Surgery
University of Utah School of Medicine
Rob Bryant MD

@RobJBryant13

NZ med school; SLC, UT, EM MD; Father, Husband, XC skier (#birkie), MTN biker. assoc. editor: REBELEM, Assoc. medical director: Classic Air Medical #FOAMed