Wound of the Month: Degloving

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Objective
Using moulage to create a realistic degloving wound (see Figure 1).

Time
5–8 minutes

Skill Level
Medium

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

Medical Glove, tan or opaque (sized as appropriate)

Latex

Red MoulageGel

Clear MoulageGel

White make-up

Flesh-toned make-up

Blood gel

Equipment

Hotpot

Scissors

Large paintbrush

Small paintbrush

Make-up sponge

Technique (see Figure 2)

Heat the MoulageGels to 150°F. Carefully remove the finger tips and “rib” from both ends of glove. (The rib is the rounded edge of the glove, where it sits at the wrist.) (See Figure 3.)

Carefully place the glove on the victim’s hand, feeding the fingers through the openings to expose the patient’s own finger tips and nail beds. (See Figure 4.)

Using latex, secure the cut edges of the finger holes to the victim’s fingers by applying latex around the perimeter, where the skin and glove meet; allow to set 1–2 minutes or until fully dry. (See Figure 5.)

Remove extra glove around the fingers as necessary to create a more natural “blend” from the victim’s natural hand to the glove. Create skin discoloration and mottling by using a make-up sponge or paintbrush that has been dipped in white make-up and lightly blot the surface of the victim’s natural skin and nail beds. Care should be taken to alternate the intensity of color placed on the skin by the amount of pressure applied to the applicator and allowing some of the victim’s natural skin color to show through. (See Figure 6.)

Create degloving skin folds by carefully moving the base of the glove forward. Carefully lift the glove at the wrist and work forward on the hand until the folds have reached the base of fingers and exposed the top of the hand. (See Figure 7.)

Using a make-up sponge that has been dipped in red MoulageGel, create the degloved area by lightly applying colorant over the entire back of the hand using a gentle blotting motion. Allow to set for several minutes or until MoulageGel is fully set. (See Figure 8.)

Using clear MoulageGel, create tendons on the back of the hand my applying a thin strip of MoulageGel, extending from the top of the hand to the bottom of the created skin fold area. Allow to set for several minutes or until MoulageGel is fully set. (See Figure 9.)

Using a small make-up brush that has been dipped in white make-up, carefully apply colorant down the perimeter of the tendons. Apply blood gel as desired to fingers and base of glove, along the skin folds.

Quick Fix

Keep pre-cut and pre-bloodied gloves in various sizes and skin tone color stored in your moulage box for a quick victim application.

Training Scenario

Dispatch: Medic 12 Respond Code 3 to Lakeshore Wood Product factory, unknown injuries. Lincoln Street, nearest cross street, Monterroy Ave. Trinity Fire responding. 1505 hours. Dispatch clear.

On Scene: Using a make-up sponge or your fingers, liberally apply white make-up to the cheeks, forehead and chin of the patient’s face, blending well. Apply a light mist of sweat mixture to the chin, upper lip and forehead. Apply soot/dirt powder to degloved arm and shirt sleeve of victim. Using a small paintbrush and blood powder, create blood stains on the front and sleeve of the victim’s shirt; lightly spray blood powder with water or setting spray to activate. Place victim flat on back, near heavy machinery or grinder. Apply a small amount of blood to equipment edge, floor and surrounding machinery. Instruct patient to respond in severe pain and agitation, with continued efforts to try and get up.

Use in conjunction with skin mottling; sweat.

Helpful Hint

Degloving wounds can be made in advance, stored covered in the moulage box and reused indefinitely. When sizing gloves for victim, choose a glove one size larger the normal to allow for “draping” of skin folds. Secure glove using latex at fingers and underneath folds as needed for stability before proceeding to “On Scene.”

Cleanup and Storage

Gently remove the glove from hand of the patient. Store the glove in a plastic bag in a refrigerator or freezer to preserve blood long term. Using a soft clean cloth or make-up remover towelette, wipe away the make-up, blood and sweat from the skin of the victim.

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.