Wound of the Month: Second-Degree Burn (Skin Sloughing)

Time

3–5 minutes

Skill Level

Intermediate

Supplies (Shop www.moulageconcepts.com for all your moulage needs)

Modeling wax

Latex

Make-up wheel, red

Make-up wheel, flesh tone; 2–3 shades darker then victim's natural skin color

Glycerin

Equipment

Make-up sponge, latex

Stipple sponge

Wax spreader tool

Paint brush, small

Technique

Using the modeling wax, create the burn area by applying modeling wax to the skin of the victim. (Note: Use an electric razor to remove hair prior to application.) Using a wax tool or your fingers, begin spreading wax across the skin in an outward direction creating a large, thin layer approximately 4 x 3 inches in diameter or 2 x the size of desired burn. See Figure 2.

Using the latex, create a barrier by applying a thin coat of latex over the modeling wax, ensuring the fluid saturates the creases and ridges for a complete seal. Let wound set for approximately 1–2 minutes or until latex is dry to the touch. See Figure 3.   

Carefully coat latex/wax application with skin tone make-up. Using a make-up sponge that has been dipped in colorant, gently blot surface until latex is fully covered. See Figure 4.

Create skin sloughing by using your fingers to push the wax and latex to the top of the burn area. (Starting at the bottom center of the burn, gently push latex and wax upwards, extending all the way to the top, while maintaining a ¼-inch latex border along the perimeter and top.) See Figure 5.

Using a make-up sponge that has been dipped in red make-up, create skin discoloration by lightly applying make-up to the newly exposed surface (where the wax and latex had been removed), and extending upward to the bottom of the skin sloughing. See Figure 6.

Using a paint brush that has been lightly dipped in glycerin, (remove excess by blotting tip of brush into a tissue), apply a light sheen to the reddened skin area.

Quick Fix

Has your burn "advanced" past the second-degree deep-partial thickness? Lighten by gently blotting burn with a large blush brush that has been dipped in setting powder. Tap edge of brush on firm surface to shake off the excess powder before applying. Apply glycerin to create sheen.

Dispatch

Medic 56, Respond Code 3 to 5198 Market Street; Caspers Assisted Living, Apt. 102, unknown injuries. Nearest cross street, Billie Road. Redbluff Fire responding. 1130 hrs. Dispatch clear.

On Scene

Using a make-up sponge, apply white make-up to the face of (elderly) victim, blending well. Apply second-degree burns to exposed skin on arm, back of hand and upper thighs. Place victim on the floor near the stove in the kitchen area. Place an over-turned pan near the victim with pools of water on the floor. Using a water bottle, saturate the front and side of the victims’ clothes until the material clings to the skin. Advise patient to groan in pain.

Use in Conjunction With

Blisters, clear

1st degree burns

Cleanup and Storage

Advise victim to carefully remove the burn from their skin; using the wax tool, scrape away the wax and latex in a gentle forward motion until all latex has released from the skin. Using a soft clean cloth or make-up remover towelette, remove the make-up and any remaining wax residue from the skin.

Visit Moulage Concepts at www.moulageconcepts.com for all your moulage supplies and training needs. Recipes are referenced from Medical Moulage—How to Make Your Simulations Come Alive by Bobbie Merica.

Bobbie Merica is the author of Medical Moulage: How to Make Your Simulations Come Alive, Moulage! Bridging the Gap in Simulation and Moulage Magic! Theatrical Tricks to Bring Simulation to Life. All works are based on her popular Moulage Mastery! Bridging the Gap^TM in Simulation workshops. She received her certification in Moulage-The Art of Injury Simulation; Biological/Chemical/Terrorism and WMD terrorism training through TEEX. Upon discovering the absence of moulage specific to a clinical/hospital setting, she designed and implemented the first of a series of 3D clinical wounds, moulage kits and courses that she teaches all over the country. She began her career as a simulation technologist with California State University, Chico, where her collaborative work in the development of the Rural Northern California Simulation Center earned runner-up honors in Advance magazine 2009 Best Nursing Team contest. She is a contributing author for EMS World and HealthySimulations.com, and medical moulage & trauma expert for the Bureau of Public Health Emergency Preparedness, AZ. For more information, visit www.moulageconcepts.com.