A banana a day keeps wound failure away: A study evaluating the utility of fruit, pig skin and synthetic skin for suturing practice

Background:

Suturing is a fundamental skill for surgeryand emergency medicine. Suturing istaught from medical school and throughoutsurgical training. However, the opportunityto practice and perfect suturing is limited bythe ethical dilemma of training on patients,and a lack of access or availability ofsynthetic skin or cadaveric animal skin.

Fruit skin, such as that of bananas andoranges, have been proposed as suitableand accessible alternatives to cadavericanimal or synthetic skin for suturingpractice. However, few studies haveanalysed how similar these are to suturinghuman skin and only one study hascompared them to another form of practicesuture material (foam skin). Moreover, allprevious studies on suturing on thesematerials have focused on describing howsuturing proficiency has changed, not onhow accurately these materials simulate theexperience of suturing in human skin. Norhave any of the studies compared howdifferent suture types such as simple,vertical mattress and subcuticular comparefor the different materials.

This study aims to explore how comparabledifferent fruit skins (orange and banana),synthetic skin and pig skin are to theexperience of suturing on human skin. Toour knowledge, this is the first study toinvestigate this. The comparability of thedifferent skins will be determined by a questionnaire completed by surgical andemergency consultants and trainees whowill attempt several different sutures on the4 materials (test skins).

Methods

Emergency and surgical consultants andtrainees will be contacted via email andinvited to attend a session to suture thematerials and assess their experience ofsuturing the materials. During the sessions,each participant will suture each of the 4materials (banana skin, orange skin, pigskin and synthetic skin) using 3 differentsutures (simple, vertical mattress andsubcuticular). The similarity of theexperience to suturing human skin andwhether they would recommend thismaterial as a practice material will beassessed using a Likert scale. Participantswill also be asked if the material simulates aparticular area of human skin.

Implications

We hope the results from this study willassist with medical education and improvesurgical training by directing medicalstudents and trainees as to which materialsthey should practice on for each suturetype.