The Evolution of Suture Training Materials

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SurgiReal products grew out of the emphasis for simulation-based training in medical education. Essentially, suturing is a basic skill expected of many professionals in the medical field, and due to the high cost of anatomy laboratories and real specimens, various types of models have been used to simulate human tissue for suture training. What follows is a review of previously used suture models along with their pros and cons.

Fruit and Sponges

Oranges, bananas, tomatoes and sponges have all been used as suture models due to their easy availability and low cost [1]. One can imagine how an orange or banana peel can act as a false skin layer for a suture needle to pass through. Or how a sponge can provide a springy layer that approximates the pliability of skin. However, with using fruits or sponges, you get what you pay for with cheap layers that do not replicate the integrity, consistency and feel of genuine human skin. As a result of these inconsistencies, the student might develop poor manual habits that may not transfer well when applied to suturing of actual human tissue, and the confidence gained with practice is lost when performing under real conditions.

Pigs’ feet

Suturing on pig’s feet has been a popular model for training. [2] This cost-effective suture model has the benefit of providing real skin and its multiple layers for suturing practice. However, the dead skin layers are quite tough – tougher than living tissue – and poor suturing habits might develop from practicing on these specimens. Further, only about 30 passes of suture can be done before the tissues start to break down. The porcine specimens must be thawed from their frozen preserved state prior to use. Just like the cadavers in the anatomy lab, the specimens are unsanitary and malodorous. Other negatives include: the pig’s feet must be stored in biomedical freezers, can only be used in a laboratory, and can be quite messy to clean up after usage. And unfortunately, some students may not be able to work on pig specimens due to religious beliefs.

Cadavers

Many medical schools still use cadavers for suture training. The human specimen gives the student a sense of realism in working on a person. The cadaver provides actual human skin and its component layers to identify, whereby the varying thicknesses of skin on different parts of the body are appreciated. Unfortunately human cadavers are becoming scarcer, and their continued use can provide some problems. Massive specialized storage is required for these specimens, and they can only be utilized in a laboratory. Therefore, a student is relegated to practicing in the lab, which may limit consistency and repetition in practice, thereby limiting skill development. And finally, cadaver tissue is not living tissue and is poorly preserved. The skin often becomes leathery and tough, which again can lead to poor suturing habits.

Synthetics

Synthetic suture pads were developed to address the problems encountered with other materials. In a previous blog post, we compared the differences between high and low quality suture pads [3]. In summary, we noted how the poor quality synthetic pads that many people are familiar with tear easily, do not hold suture tension, and pull entire chunks of silicone out when the suture is pulled tight. Pads made from foam or low quality silicone can only be used a few times per incision. Some low quality pads have an unnatural greasy or slimy feel to them. Many of these synthetic pads do not have actual layers but are just a single block of silicone that changes colors from one ‘layer’ to the next in an otherwise uniform consistency. Now when designed properly, as with SurgiReal, high quality synthetic pads can be realistic and mimic live human skin. These high quality pads can be reused multiple times on each incision (greater than 15 times), can be used anywhere for practice (not just the lab), and are not cost prohibitive for student use.

References

1. Gonzalez-Navarro, A.R., Quiroga-Garza, A., Acosta-Luna, A.S.et al. (2021). Comparison of suturing models: the effect on perception of basic surgical skills. BMC Medical Education, 21, https://doi.org/10.1186/s12909-021-02692-x.
2. Fargo, M. V., Edwards, J. A., Roth, B. J., & Short, M. W. (2011). Using a simulated surgical skills station to assess laceration management by surgical and nonsurgical residents.Journal of graduate medical education, 3(3), 326-331. https://doi.org/10.4300/JGME-D-10-00208.1
3. https://surgireal.com/blogs/news/comparing-high-quality-suture-pads-to-subpar-alternatives.