The Importance of Layers in Suture Pads
SurgiReal specializes in highly realistic, layered suture pads. For example, our 6-layer pad mimics the epidermis, dermis, subcutaneous, first fascia layer, muscle, and second fascia layer of a patient. This complexity allows for multi-layer closures, which simulate a variety of procedures such as deep wounds, superficial sutures for shallow closures, and subcuticular sutures for more delicate areas. Each of these procedures must be practiced and performed at different levels of tissue. In order to adequately simulate what this feels like on a live patient, each of these layers must be identified and felt for in the practice material. Realistic suture pads that allow students to do this can improve suturing technique and confidence . While practice and repetition are critical to developing these suture skills, the importance of a quality, layered suture pad should not be overlooked.
Limitations of no layers
It is true that any practice is better than no practice, so many students and instructors find themselves relying on lower quality suture pads and materials. These often do not have any layers or that represent layers in superficial ways. While these pads may seem like a cost-effective option for practice, they tend to rip and shred rapidly with use. Their lack of realism and durability can also lead to the development of bad suturing habits that must be re-learned once students take their suturing tasks to live patients.
For example, some practice devices rely on different colors to represent each layer of skin rather than actual, tangible layers. This can help learners visualize the location of layers, but does very little to help them learn the tactile sensations of maneuvering through those different layers. As such, these devices support students as they learn the basic motions and theory of suturing, but do not necessarily lead to a strong understanding of the various depths and levels to the tissue that is needed in order to differentiate the layers for the sutures. Additionally, different suture techniques are practiced within different layers of tissue. If a pad material does not have layers, it limits what instructors can demonstrate and what students can practice.
Limitations of low-fidelity layers
Some suturing pads may strive to remedy the limitations of no layers by providing a limited number of layers. In some cases, this might be a thin covering of silicone set over a foam pad. Again, this is better than no layers, but having such a low-fidelity model can limit the suture techniques that can be taught and the depth of understanding that students can achieve. Once students begin to work with patients, they need to know what it feels like to cut through epidermis, dermis, subcutaneous fat layer, fascia, and muscle in a variety of procedures. Unlike a foam practice pad, SurgiReal’s 6-Layer suture pads can replicate these layers in a meaningful way.
Pigs’ feet and cadavers are often cited as preferred tools for use in suturing practice because they do have appropriate layers and, as such, are of higher fidelity than some suture pads. While these may do a better job helping students understand some differences between layers than tools with no layers might, both pigs’ feet and cadavers are composed of dead tissue, which does not respond the way live human tissue responds. Dead tissue is often tougher and the tension within and across each layer is different than it is in live tissue . Students who practice with these may find that they need to do some re-training once they enter the workforce in order to fully grasp how live tissue should respond.
Having a strong grasp of how different layers of tissue should feel can also improve students’ incision techniques. Ideally, a live patient should not be a practitioner’s first experience making a real incision. High-fidelity suturing pads ensure that patients are not being used as practice as students familiarize themselves with layers of live tissue. This leads practitioners who are better equipped to create incisions.
SurgiReal’s suture pad layers
Using layered, high-fidelity suture pads for learning ensures that students’ practice translates well to real-life situations. SurgiReal strives to develop suture pads that meet these standards. Our suture pads mimic every layer of tissue a practitioner might need to work with. They are uniquely formulated and reinforced to replicate the corresponding real-life tissue layer, making them the most realistic pads available. The high-fidelity of the layers ensures that instructors can demonstrate any procedure or technique that will benefit their students as those students move into the role of practitioners.
 Shen, Z., Yang, F., Gao, P., Zeng, L., Jiang, G., Wang, S., Ye, Y., & Zhu, F. (2018). A Novel Clinical-Simulated Suture Education for Basic Surgical Skill: Suture on the Biological Tissue Fixed on Standardized Patient Evaluated with Objective Structured Assessment of Technical Skill (OSATS) Tools. Journal of Investigative Surgery, 31(4), 333–339. https://doi.org/10.1080/08941939.2017.1319994
 Rothenberger, J., Seyed Jafari, S. M., Schnabel, K. P., Tschumi, C., Angermeier, S., & Shafighi, M. (2015). Evaluation of Medical Students’ Attitudes and Performance of Basic Surgery Skills in a Training Program Using Fresh Human skin, Excised During Body Contouring Surgeries. Journal of Surgical Education, 72(5), 868–874. https://doi.org/10.1016/j.jsurg.2015.03.004