19 Suturing model made from socks and T-shirt

Proper surgical technique, like any clinical skill, improves with practice.  Practice can be done almost anywhere at any time given appropriate models and instruments to practice with.  Rubrics guide the proper steps to take and give guidelines for proper technique.  Getting feedback is vital to skill acquisition

1. Become familiar with the basic who, what, why, when, where, how, and how much? of the procedure to give you some clinical context for the procedure
2. Learn the steps of the procedure visualize, verbalize, and do
3. Use rubric provided, tag words to trigger memory are helpful
4. View video if provided-videos are very sticky to your brain!, so make sure its a good one! (the internet is full of questionable techniques)
5. Make or use a study guide if provided
6. Practice with direct supervision for real-time feedback to be sure you have the correct technique before really diving into practice.  Early learning is sticky and its hard to unlearn and relearn!

Part of practice is having a model that recreates the important elements of practice that can be translated to practice on cadaver, and then eventually to a live animal.  Good technique should be accomplished before performing surgery on a live animal.  We all start as Novices,  through Advanced Beginners, to Competent and ultimately after sometimes years of practice Proficient.

This model was conceived by me in a hurry to find something students could observe via ZOOM and practice suturing at home during the middle of Spring semester due to COVID-19 protocols.

List of supplies from around the house to make a suturing model that replicates the peritoneum, linea alba, SQ fat and epidermis is found below, as well as a video that shows and discusses how to put it all together and use it! List is in order of how you put together the model…Of course use your imagination and knowledge of anatomy to make your own version!

1) Bread bag or newspaper bag-represents the peritoneum, stuffed with crumpled paper or other socks-represents the abdominal contents

2) Sock with 4 cm length of white tape on longitudinal midline just through the plantar side of sock-represents linea alba (tape can be any color) tape gives sock a more firm feel as linea alba is connective tissue.  *Easiest at this point to make incision through tape/plantar surface only of the sock along midline of tape, then pull sock over the stuffed bag.

3) 2 fluffy socks one inside the other also with midline 4 cm slit along the dorsal only part of the sock (less compressed as not walked on)-represents SQ fat.  Pull these socks with slits aligned, over the assembly so far.

4) Lay an old T-shirt on a flat surface like table top with sock assembly in the middle-use a tape measure or length of paper strip to measure the circumference of the sock at mid point of the aligned incisions.  Fold inward the sides of the T-shirt to create double thickness such that the width of the T-shirt matches the circumference of the sock assembly and bring the folded edges to center line meeting at the aligned incisions.   Place tape distal and proximal to the edges of the incision in the sock assembly to complete.

This builds an inexpensive way to practice skin suturing and importantly subcuticular suturing allowing for practicing the buried knot technique.

Click here for video on how to make this model