Mastering Suturing Under Pressure: Why Realistic Bleeding Simulation Matters

Here at SurgiReal, we believe perfect practice leads to the best outcomes for medical students and their patients. Our RealSkills® series tackles fundamental clinical tasks to support medical instructors and their students as they build competence and confidence in these essential skills. Today’s skill: Suturing Under Pressure. Let’s dive in!

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Suturing is a cornerstone skill for medical professionals, from emergency room physicians to wound care experts. However, mastering this skill is less about perfecting stitch techniques and more about performing a skin suture under pressure.

Many students train on dry, static suture pads that fail to replicate the real-world challenges of blood vessels, tissue reactivity, and wound tension. This can lead to common mistakes like improperly handling suture needles, misjudging blood supply, or using the wrong suture types for different wound locations.

A clean, dry incision isn’t what students will encounter in an operating room or trauma bay. They’ll need to manage deep wounds, cosmetic wounds, complex lacerations, intraoral lacerations, and traumatic lacerations, all while keeping bleeding under control. This is why realistic bleeding simulation, like the RealFlow® Suture Pad, is necessary for skill development.

In a controlled classroom setting, suturing may seem straightforward, but in real-world environments, even minor mistakes can lead to poor healing, infection, or failed closures. Understanding these errors helps students build the skills needed for safe, effective wound closure under pressure.

Incorrect Suture Selection for the Wound Type

The correct suture is necessary for healing. Students may rely on a single material without considering wound depth, tissue type, or infection risk.

• Braided sutures offer strong knots but can trap bacteria, increasing infection risk in deep wounds.

• Synthetic sutures (e.g., monofilament) are better for cosmetic and straight wounds due to reduced scarring.

• Absorbable sutures suit subcutaneous tissue, while non-absorbable ones are ideal for external closures.

Incorrect selection can cause poor healing, excessive tension, or suture rejection.

Poor Knot Security and Suture Loop Management

Stress often leads to rushed suture loops, resulting in knots that are:

• Too tight, restricting blood supply and damaging tissue

• Too loose, causing wound edges to separate, delaying closure

• Uneven, leading to poor alignment and inconsistent outcomes

This is especially problematic in continuous sutures, where maintaining proper minimal tension is critical.

Inconsistent Suture Spacing and Depth

Inconsistent spacing affects wound integrity and healing time. Wide spacing between sutures creates gaps that increase the risk of infection. Additionally, Shallow stitches in the superficial dermis may fail, while deep stitches can cause unnecessary scarring. In vertical mattress sutures, shallow bites may cause wound edges to roll, impairing healing.

Failure To Control Bleeding Before and During Suturing

Active bleeding complicates wound closure, leading to:

• Obscured visibility, making alignment difficult

• Compromised knots, as blood makes needles and suture material slippery

• Delayed suturing, increasing infection risk

Practicing with bleeding suture models, like the RealFlow® Suture Pad, helps students develop real-time hemostasis strategies before working with live patients.

How Bleeding Affects Wound Closure — Why Standard Suture Pads Fall Short

Real surgical and trauma wounds don’t remain still and dry like traditional silicone suture pads. Blood flow, tissue elasticity, and wound tension all affect wound closure and healing, making realistic practice essential.

Bleeding obscures wound edges, leading to misaligned stitches, unintended suture placement, and compromised deep dermis repair. Static suture pads don’t prepare students to adjust their technique while managing active bleeding.

Uncontrolled bleeding also increases the risk of infection by harboring bacteria, which can lead to delayed healing, abscess formation, or wound dehiscence if you fail to properly address them.

Additionally, blood flow impacts suture choice and technique. Highly vascular areas need minimal tension sutures to prevent scarring, while complex wounds often require multiple suture types for effective closure. Intraoral lacerations, which bleed heavily, demand rapid primary closure to avoid infection and tissue damage.

Why Realism Matters: Evidence-Based Benefits of Bleeding Simulation Training

Realistic bleeding simulation is a proven method for improving clinical performance in medical students. According to a study published in Open Nursing, exposing students to high-fidelity simulations (HFS) significantly boosts learning retention. It improves practical skills in nursing procedures applicable to real-world settings. This finding supports the importance of training on bleeding models like the RealFlow® Suture Pad, which replicates the dynamic challenges of wound closure under pressure.

Another study suggests that while more realistic simulations don’t always outperform simpler models regarding learning outcomes, adding realistic elements supports the simulation experience. The result is that students are better prepared for real clinical situations, where factors like bleeding control, tissue management, and time pressure are critical.

Realistic simulation bridges classroom learning and clinical practice. Students who practice with realistic bleeding models build essential skills such as hemostasis and suture selection while building confidence and competence in managing real patient care.

Hands-On Training Tips: Timed Suturing Drills With the RealFlow® Suture Pad

How To Set Up a High-Pressure Suturing Drill:

1. Set up the RealFlow® Suture Pad to simulate an actively bleeding wound.

2. Assign different closure techniques, including:

   • Simple suture for minor skin surface wounds.

   • Continuous suture for long, straight wounds.

   • Vertical mattress suture for deep wounds requiring high-tension closure.

3. Time each student to perform a repair procedure, adjusting for blood loss.

4. Introduce variables, such as unexpected bleeding or tissue damage.

5. Evaluate: Did the student achieve minimal tension, secure the suture loop, and maintain an even wound edge closure?

These drills prepare students for the realities of control during laceration repair so that they can work efficiently and confidently even when faced with complex wounds.

From Practice to Patients: Building Confidence in Suturing

Mastering suturing under pressure is more than learning suture techniques — it’s about developing the confidence to work through active bleeding, poor wound healing conditions, and challenging tissue reactions.

The RealFlow® Suture Pad from SurgiReal brings together classroom learning and real-world wound closure so that future healthcare professionals are fully prepared for any common procedure. Explore SurgiReal’s bleeding simulation tools today.