Wound of the Month: Open Pneumothorax (Sucking Chest Wound)

A guide to simulating injuries through effective use of moulage


Objective
Using moulage to create a realistic sucking chest wound (see Figure 1)

Time
15–20 minutes

Skill Level
Advanced

Supplies
(Find supplies and more at www.moulageconcepts.com.)

Flesh MoulageGel

Red MoulageGel

Bridal netting, clear, 1 inch × 1 inch

20cc syringe

Extra MoulageGel bottle

IV tubing

1 cup water

1 drop red food coloring

1 teaspoon dish soap

Equipment

20cc syringe

Bowl

Hotpot

Laminated board

Palette knife

Filter needle

Small paintbrush

Tweezers

Technique

Heat the MoulageGel to 140°F. On a laminated board, combine 10cc of flesh-colored MoulageGel with 10 drops of red MoulageGel. Stir the MoulageGel material thoroughly with the back of a palette knife to blend, creating a pink color. Allow the mixture to set fully before pulling up and re-melting in extra MoulageGel bottle for later use.

On the laminated board, create a thick, approximately 1/4 inch wide × 4 inch long, rope of fat, using the pink MoulageGel. (See Figure 2.)

Using a palette knife, create two 4 inch pieces of fat by running the palette knife down the center of the fat rope, lengthwise from end to end. Using the palette knife, cut both fat ropes in half, creating four, 2 inch ropes.

On the laminated board, create a small, approximately 1 inch diameter basic skin piece (base piece) using flesh-colored MoulageGel. While the skin piece is still in the sticky stage, center the bridal netting on the MoulageGel base piece.

Using tweezers, place a small, approximately 1 inch, circle of fat around the perimeter of the base skin piece, securing the pieces in place with flesh-colored MoulageGel. (See Figure 3.)

Using MoulageGel, secure additional pieces of fat along the inside perimeter of the fat rope, taking care to ensure the center remains clear of MoulageGel. Using the IV tubing as a guide, place tubing end side down, centered on the base piece. Begin filling the area around the IV tubing with additional “chunky” pieces of MoulageGel material that have been pulled from the fat rope and glued along the inside edges. Remove IV tubing from the base piece; let this sit approximately 3 minutes or until firmly set. (See Figure 4.)

On the laminated board, create a basic skin piece (crown) approximately 2.5 inches in diameter, using flesh-colored MoulageGel; let the MoulageGel sit approximately 1minute or until firmly set. Using the tip of your palette knife, cut an “X” in the center of crown piece. Carefully remove flaps from the “X,” creating an opening or hole that is slightly smaller than the perimeter of the fat on the base piece. (See Figure 5.)

Gently lift the crown skin piece off the board and place it on top of the fat and base skin piece, maneuvering it in place until fat protrudes through the created opening at the “X.” (See Figure 6.)

Gently pipe in extra flesh-colored MoulageGel material under the crown skin piece along the opening to fill in any holes or air pockets. Using your finger that has been dipped in hot water, smooth any air pockets or wrinkles from the surface of the crown piece.

When the wound is set, carefully lift the wound and flip it over, facedown, and add MoulageGel material where the base piece meets the crown piece to strengthen any weak spots on the underside. Smooth any ridges by dipping your finger in hot water and running over the heated gel. Flip the wound back over, face up, and allow it to sit at least 3-4 minutes or until fully set.

Using a filter needle, create a small opening in the center of the wound by forcing the tip of the needle down through the center and protruding from the other side. Carefully increase the size of the opening to approximately 1/8 inch by maneuvering the needle in a circular motion while applying light pressure. (See Figure 7.)

Working from the underside of the wound, gently push the tip of the tubing up and through the wound cavity, approximately 1/16 inch. Carefully secure the tubing in place by applying additional MoulageGel material around the perimeter of the tubing (do not occlude tubing) and along the underside of the base piece; let this sit approximately 2 minutes or until firmly set. (See Figure 8.)

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