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Help with creating a suture kit

MedicalKit

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May 29, 2020
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  1. Pre-Medical
[ NOTE: I read SDN Forum rules, and I believe that I am not breaking any rules as I am just asking for an opinion. But please delete this post if this breaks any rules! ]

Hello everyone! Fellow senior undergrad student here with an interest in medicine (but have not decided yet).

I have a hobby in ecommerce and I am developing a new product for medical students and residents.

The problem is that a lot of suture kit companies are not working with medical students and you can tell because their skin pads don't resemble real skin.

My goal is to make the suture pad as realistic as possible to real skin because what I see on the market feels like rubber. I also want to make it even more affordable than others on the market.

If you have the time, please share your opinion on what you hate, love and want in a suture practice kit. It would mean the world to me!

Some suggested questions I would love if you answered (you don't have to answer all of them):

  1. What do you hate about the suture kits that exist on the market? What do you love about them? What do you want?
  2. Do you have any ideas on how to make the skin feel more realistic and prevent tear when suturing? Perhaps using another material or introducing meshes in between layers of skin?
  3. Is there something you wish you had more of in a suture kit? Example: would you be willing to sacrifice the fancy vegan leather tool case for better quality tools, more needles, more variety of sutures?
  4. Would you like an ebook or video training series by a real medical professional?
  5. Is the aesthetic of the fake silicone skin good enough? Or would you rather want a skin pad that is ultra realistic with skin texture and color?

Thank you for your help!
 

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libertyyne

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OK, for anyone throwing in simple subcuticular knots or trying to approximate using the appropriate tension most suture kits are trash. They end up ripping the moment i put any tension on them.
The needle drivers and foreceps are usually also low quality.
There should be a subset of this market dedicated to higher quality higher strength kits dedicated for medical students trying to go into surgery.
The other trash ones are probably ok for most students tho because most of my fellow classmates going into non surgical fields wouldnt even know how to do a hand tie.
 
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cookiegrub

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Oct 8, 2016
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the kits are rubbery and don't have any changes in texture. Essentially, the skin layer may be slightly tough but feels of the same gelatinous consistency as the other layers. Real skin has tension and the underlying dermis is softer and easier to pierce through, providing a satisfactory tug when you loop the needle out of the skin. Based on this proper consistency, you become aware that your knot is going to approximate the skin just right as opposed to the fake kits where there may be a tiny gap after placing the knot. Additionally, like my colleague mentioned above, as soon as you try to close the knot down, the entire loop comes out of the fake model because of its flimsy nonvariant layers.

However, they are not bad and I personally think that my kit didn't cost all that much provided how many suturing threads and tools they gave in the pack.
 

FindersFee5

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OK, for anyone throwing in simple subcuticular knots or trying to approximate using the appropriate tension most suture kits are trash. They end up ripping the moment i put any tension on them.
The needle drivers and foreceps are usually also low quality.
There should be a subset of this market dedicated to higher quality higher strength kits dedicated for medical students trying to go into surgery.
The other trash ones are probably ok for most students tho because most of my fellow classmates going into non surgical fields wouldnt even know how to do a hand tie.

Definitely agree with this. Any monofilament tore right through my kit and even with silks I had to be super careful when tying knots. The attempts at different layers are also very silly.

It should have a super fibrous top layer - skin is WAY stronger than these companies think! And have some easy way to secure it to whatever you're working on so that you aren't jerking it all over the place.
 

longhaul3

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When I used one of these I couldn't tell which parts were supposed to correspond to which layers of skin. Understanding and working with needles and suture in the different layers of the skin is the most important part of learning to suture. Skin separates from the underlying tissue in a way that lets you get underneath it and evert the edges, which is a fundamental technique in suturing. That is not at all possible with these pads.

Another important part of suturing is understanding how to use tension. Adding some kind of suction cup or adhesive device to the bottom to help anchor the pad would make it much more realistic, although as others have said the standard silicone material doesn't hold up well to tension.
 

MedicalKit

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May 29, 2020
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Thank you for the responses! This is REALLY helpful. I noticed that the same issue is repeated multiple times so it is important to fix it. This is what I got from your comments:
  • Withstand tension and not tear so that the sutures stay in place, especially when tying knots. I will put a lot of emphasis on testing simple subcuticular knots.
  • Realistic layers of skin to ensure they are not the same: Changing the layers within the skin pad so that the topmost skin layer is tougher and the underlying layers are softer so that it is easier to pierce through. Skin should separate from underlying tissue so that you can “get underneath it and evert edges”
  • Look for a material that won't allow hair (especially cat hair) to stick to it. If not possible, protective film cover to put over skin pad so that when not in use, the cat hair won't get on it.
  • A subset of market dedicated to higher quality kits dedicated to med students getting into surgery
  • Some way to secure the skin pad so that it stays put because the silicone material slides on the surface
  • Include needle drivers and foreceps of higher quality. Perhaps sacrificing the quality of the carrying case and put that money into better quality tools.
I also agree that the kits on the market are OK for general practice and not those going into surgery. However, I would still like to fix up the general kits because the people not going into surgery deserve to have better quality kits. No one is putting pressure on the companies to make better kits as they all have the same supplier and new molds would cut into their profits, so why should they?

One last question I have:
Are the variety of wounds on the skin pad realistic to the wounds you work with? Are there any wound cuts you would rather have more of? Less of? Are there any that the existing kits do not have yet? I want to know if this is something that is important enough to change.
 

FindersFee5

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Jun 22, 2016
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Thank you for the responses! This is REALLY helpful. I noticed that the same issue is repeated multiple times so it is important to fix it. This is what I got from your comments:
  • Withstand tension and not tear so that the sutures stay in place, especially when tying knots. I will put a lot of emphasis on testing simple subcuticular knots.
  • Realistic layers of skin to ensure they are not the same: Changing the layers within the skin pad so that the topmost skin layer is tougher and the underlying layers are softer so that it is easier to pierce through. Skin should separate from underlying tissue so that you can “get underneath it and evert edges”
  • Look for a material that won't allow hair (especially cat hair) to stick to it. If not possible, protective film cover to put over skin pad so that when not in use, the cat hair won't get on it.
  • A subset of market dedicated to higher quality kits dedicated to med students getting into surgery
  • Some way to secure the skin pad so that it stays put because the silicone material slides on the surface
  • Include needle drivers and foreceps of higher quality. Perhaps sacrificing the quality of the carrying case and put that money into better quality tools.
I also agree that the kits on the market are OK for general practice and not those going into surgery. However, I would still like to fix up the general kits because the people not going into surgery deserve to have better quality kits. No one is putting pressure on the companies to make better kits as they all have the same supplier and new molds would cut into their profits, so why should they?

One last question I have:
Are the variety of wounds on the skin pad realistic to the wounds you work with? Are there any wound cuts you would rather have more of? Less of? Are there any that the existing kits do not have yet? I want to know if this is something that is important enough to change.

Wound cut variety doesn't matter. A vast majority of the skin closures are linear or essentially linear, especially those med students are asked to do.
 
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The Knife & Gun Club

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I’m gonna shoot you strait. It doesn’t matter how similar to skin it is. The maneuvers of simple suturing are very much an effect of memory of the steps, not the feel. At higher levels this isn’t true, but for an MS _, it doesn’t matter.

that said my favorites have been the foam with a fake leather type material over it. Replicated the fact that skin is tougher than expected, and subcutaneous fat is weaker than expected.
 

The Knife & Gun Club

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Hollywood Upstairs Medical College
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Oh, and the vast majority of closures you’ll do as a student are closing superficial skin cut in a straight line by a scalpel after surgery. So a line is fine. I think most kits add those other shapes to just look cool.

I know when I was an M1 shopping for these I got one with all kinds of fun shapes. but reality was I needed one with like 10 vertical parallel lines lol
 
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mehc012

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Oh, and the vast majority of closures you’ll do as a student are closing superficial skin cut in a straight line by a scalpel after surgery. So a line is fine. I think most kits add those other shapes to just look cool.

I know when I was an M1 shopping for these I got one with all kinds of fun shapes. but reality was I needed one with like 10 vertical parallel lines lol
Not to mention that when you are given one with less uniformity (say, in the ED), it's not just a 'cool ziggy shape', but also varies in depth, level of tissue damage, surrounding injuries, etc. Learning to close those is less about the shape, and more about learning viable vs nonviable tissue and the fact that the human body is just surprisingly good at putting itself back together.
 
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kraskadva

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QUOTE="MedicalKit, post: 21915198, member: 1055316"
  1. What do you hate about the suture kits that exist on the market? everything basically. the pads are trash, the instruments are equivalent to what you get in a disposable suture kit in the ED, so practice for that I guess, but nothing like what you use in surgery, where someone's looking over your shoulder and judging you out loud. Specifically the length (surgical are longer) and the joins (the ones in kits have a gap behind the hinge when closed that the suture gets caught in) What do you love about them? nothing What do you want? better tools mostly. I just go buy meat if I want to practice, but the tools are the real thing.
  2. Do you have any ideas on how to make the skin feel more realistic and prevent tear when suturing? Perhaps using another material or introducing meshes in between layers of skin? IDK about what non-biologic materials would work best for this, but the closest animal approximation is actually tongue. Folks use pigs feet bc they're cheapest, but the skin is much thicker than people. Tongue is not much more money, but is the best approximation at the store.
  3. Is there something you wish you had more of in a suture kit? Example: would you be willing to sacrifice the fancy vegan leather tool case for better quality tools, more needles, more variety of sutures? better tools
  4. Would you like an ebook or video training series by a real medical professional? unnecessary. there are roughly 10k videos on YT
  5. Is the aesthetic of the fake silicone skin good enough? Or would you rather want a skin pad that is ultra realistic with skin texture and color? nobody cares what it looks like. though darker skin tones would be helpful. Folks get used to practicing on peach color, and black sutures on black skin are harder to see, so better to practice with a darker color. Though if that disintegrating silicone-mineral oil-stickiness could be done away with, that'd be great.
/QUOTE
 
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