LECZENIE RAN 2024; 21 (3)

Technique for creating simulated wounds

One key element of medical simulation is realistically reproducing wounds and injuries. These are usually created from materials such as silicone, latex, or polyurethane, attached with special glue or tapes. In addition, preparations based on water, food dyes, and glycerol are used to mimic blood, cerebrospinal fluid, and pus, for example. Adding devices that simulate bleeding or exudation from wounds enhances the participants’ immersion in the scenario and their realistic performance [5, 6].

Wounds applied to simulators or simulated patients should be visually and tactilely similar to real ones. Many companies offer a wide range of wound simulation kits. Among them can be distinguished:

Wound care and dressing models also imitate internal structures, i.e. bones, muscles and blood vessels (Fig. 1). Mainly used for learning to assess the type of wounds,

Taped wounds and injuries in a roll need to be trimmed (Fig. 2). They have great variety and ease of application on simulators. They are more challenging to place on the body of the simulated patient; sets of silicone inserts dedicated to high-fidelity simulators and trauma modules (Figs. 3 and 4), step modules for pressure sores and other chronic wounds (Fig. 5). They require skill in application and have the advantage of high realism.

In addition, simulation technicians apply characterization techniques used in the film industry, such as petroleum jelly, liquid latex, and specialized cosmetics (Fig. 6).

New technologies, 3D printing, and familiarity with characterization techniques allow for an even more realistic reproduction of anatomical structures, which increases the effectiveness of the training provided (Fig. 7) [5, 6].

An exciting area of the use of simulated wounds is the study of the effects of damaging factors on tissues. This helps to understand the impact of forces on the human body during the development of an injury. This is especially true for gunshot wounds since gelatin and glycerin soap have approximately the same density as human tissue. The effects of gunshots are comparable to those in human tissue [1, 7].

Articles also report the use of simulation models in teaching surgical development of abscesses (Fig. 8) or escharotomies using not only ready-made models but also those created by technicians from everyday substances such as toothpaste, orange peels, sponges, and silicone skin [8–10]. Creativity and using such products significantly reduce the cost of producing wound models.

Advanced high-fidelity simulators in medical simulation make it possible to relate many injuries to physiological effects. With such technology, it is possible to create “clinical states” of patients, including physiological disorders such as airway obstruction, hypovolemia, fever or circulatory failure (Fig. 9). This allows the critical thinking component to be perfected during the didactic sessions [5, 11, 12].

Using crafted wounds on simulated patients is one of the more modern teaching methods. A study conducted by a research team from Australia found that the simulation intervention facilitated the development of basic wound care skills. Students were eager to work with simulated patients, recognizing the value they bring during simulation sessions [13]. Working with an actor provides students with a safe, structured learning environment and the acquisition and refinement of communication skills, preparing them for the complexity of situations they encounter in clinical practice [13–15]. Using crafted wounds or creating casts of particular types of wounds and using them on a simulated patient increases the participants’ perception of the realism of the injuries and the immersion in the scenario. Additionally, this enhances the learning experience and authenticity of clinical simulations [12, 16].

Using in situ simulation, that is, simulation in a natural patient care environment such as a hospital ward, also seems promising. However, this type of training has yet to be widespread in Poland. In situ simulation improves reliability and safety, especially in areas involving high patient risk [17].