Suturing models – cost, efficiency, and preference
Authors: Guzman-Lopez Santos , Quiroga-Garza Alejandro , Gonzalez-Navarro Alejandro Rafael , Elizondo-Omaña Rodrigo Enrique , Salinas-Alvarez Yolanda , Martinez-Garza Javier Humberto , Jacobo-Baca Guillermo , Zarate-Garza Pablo Patricio 
Published: April 2020

Introduction

Basic surgical skills such as suturing, need to be developed by physicians and reinforced with practice during medical school. The skill should be acquired during the first years of medical school in the anatomy course, suturing cadavers, but with tendencies to reduce laboratory hours and cut cadaver programs, other resources must be used, as well as for advanced suturing practice. Several studies report de use of diverse materials for practice, most that can be categorized under as: synthetic materials, biological (human/animal) tissues, fruits, or commercially designed samples. Our goal was to determine the most effective model for developing basic suture skills by analyzing the characteristics of the points made and the student’s perception and cost.

Materials and methods

A suturing course was offered to medical students who wished to voluntarily participate in the evaluation study. Signed informed consent was obtained previously.

Phase 1

All students went to a suturing 1‐hour class (theory) then passed to the laboratory for practice.

Phase 2

They were randomly divided into 4 groups and were allowed to manipulate suturing models, one from each category (2‐inch thick sponge [cost: <$1 USD for a 6×6 inch block – reusable until damaged], fresh pig‐skin with 1‐inch subcutaneous tissue [cost: ~$2 USD for a 6×6 inch block – reusable during the day o if frozen for 2 or 3 workshops], freshly peeled orange [<$1 USD for two halves of an orange – one time use], and a commercial silicone suturing pad [University produced ~$1 USD for a 4×4 inch block – reusable until damaged; commercial brand ~$25 USD) in any order they wished, suturing at least 2 simple sutures and 2 continuous sutures with Nylon 3‐0. making at least 2 points per model.

Phase 3

Students were asked to complete 3 simple and 3 continuous sutures on each model, registering time and answering a 7‐point Likert questionnaire between each model. Sutures were also graded by two observers using a quality suture rubric. At the end of the practice, students were asked to sort models from best to worst in accordance to their own perception.

Results

A total of 60 students participated. The model in which students could suture the fastest was the sponge (10.57 ± 4.08min) followed by the orange (12.87 ± 5.04), the commercial model (14.28 ± 5.35) and the pig skin (15.79 ± 6.02). The preferred model was the pig skin, followed by the sponge. The highest satisfaction on the Likert scale was the sponge (2.26 ± 1.7) followed by the pig skin (2.52 ± 1.22). Simple and continuous sutures had the highest quality score in pig skin (2.45 ± 0.46 and 2.22 ± 0.55) followed by the sponge (2.48 ± 0.54 and 2.27 ± 0.53).

Conclusion

The satisfaction that students have when using the models was related to material management. Sponge and pig skin are both economic options with similar results, although pig skin is more similar to human skin (which dictates an important role in acquiring the practice‐based skill), and requires more hygienic care during and after the practice.