Wound of the Month: Frostbite

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

Time:

5-7 minutes

Skill Level:

Advanced

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

• Silifex Gel set
• Make-up stix, black
• Make-up stix, red
• Make-up stix, burgundy
• Make-up stix, white
• Latex, clear
• Soot powder
• Setting powder, translucent
• Caramel colorant, thinned

Equipment:

• Palette knives
• Make-up sponge
• Laminated board
• Blush brush
• Paint brush, small
• Fan brush
• Blow dryer

Technique: (see Figure 2)

Using separate palette knives, remove a small amount (approximately the size of dime) of  Silifex gel A & B in equal portions and place on board to activate. Note: To ensure long term integrity of both products, use separate palette knives or utensils to remove product from each container prior to combining on palette board, as the combination of products creates a chemical reaction that readies it for use.

Using the back of palette knife, combine gels, mixing thoroughly until fully incorporated. Using a make-up remover or dry cloth, clean residue from back of palette knives. (see Figure 3)

Using a paint brush or your fingers, begin spreading a thin layer (approximately 1/8" thick) of Silifex over the joints and downward toward the tips of the fingers, stopping about 1/2 to 1 inch short of the nail bed. Rotate hand to ensure the Silifex wraps completely around the affected fingers, covering both the top and underside. Using a blow dryer on low-cool, gently dry the Silifex until set, approximately 1 minute, or allow to air dry 2-3 minutes and until dry to the touch. Along the tips of the fingers and nail beds, apply a thin coat of clear latex and allow to dry. (see Figure 4)

Using your fingers or palette knife, gently lift the edges of the Silifex (toward the nail bed). Using a small amount of pressure, push the skin flap backward, (toward the knuckle) to create skin puckering, gluing in place as needed with a small amount of Silifex. (see Figure 5)

To set Silifex and ready for make-up, carefully coat top of Silifex with translucent powder or skin tone make-up. Using a make-up blush brush that has been dipped in translucent powder, (gently tap edge of brush to container to release the excess powder) brush the Silifex until surface is matte or no longer shiny. (see Figure 6)

Using a small paint brush, apply a light coat of black make-up (stix) over the exposed skin, extending from the nail beds upward to the (Silifex) skin edge.  Along the (Silifex) skin edge, create a mottled appearance, allowing some of the natural skin to show through. (see Figure 7)

Using a small paint brush that has been dipped in soot powder, create areas of severe frostbite by applying the powder (over the latex) along the ends of the fingers and nail bed. (see Figure 8)

Using a make-up sponge, create skin reddening by gently blotting the red colorant over the back of the hand and fingers. (see Figure 9)

Using a fan brush, intensify the skin reddening over the knuckles and joints by gently applying burgundy over the existing red colorant. (see Figure 10)

Using a small paint brush that has been dipped in white make-up, (stix) create skin whitening along the finger joints, (Silifex edge) creases between the fingers and knuckles. (see Figure 11)

To highlight nail bed trauma, apply additional whitening around the nail bed edges, wiping away the excess as needed with a Q-tip. (see Figure 12)

Using a paint brush that has been dipped in thinned caramel color (1/4 drop of caramel to 4 drops of water) create wound depth by applying colorant to peeled skin opening (along the puckered edges of the Silifex). Lift away excess caramel coloring using a damp Q-tip as required. (see Figure 13)

Create additional frostbite burns to the palm and underside of the fingers as desired.

Quick Fix:

Need a quick frostbite? Frostbitten fingers can be made ahead of time and glued to your knuckles. Using Great Stuff gap filler, create fingers by placing 1 1/2 -2 inch beads of gap filler on wax paper. (When creating the beads, one end will be thicker than the other. Strive for beads that are approximately 1/4 inch wide, tapering down to 1/8 inch on the opposite side). Using a small knife, hollow out the thicker end of the bead so it fits comfortably over the knuckle of your fingers. Using black spray paint, thoroughly coat the "fingers" with paint. To highlight nail bed trauma, apply additional whitening around the nail bed edges, wiping away the excess as needed with a Q-tip.

To apply: Bend your fingers into the palm of your hand, holding each finger in place with a drop or two of spirit gum. Affix "frostbitten fingers" to your knuckles using Silifex or clear latex.

Training Scenario:

Dispatch: Medic 52, Respond Code 3, Mt. Briyon ski resort & lodge. Search & recovery in progress following avalanche earlier this week. Nearest cross street, Forest Mill Rd. Marin County Search & Rescue, El Domino Fire with multiple agencies' assistance. 0815 hrs. Dispatch clear.

On Scene: Using a make-up sponge, apply white make-up to the face of the victim, blending well into the hairline. Using a blush brush that has been dipped in white make-up, create skin mottling on the feet, legs and arms of the patient. Discolor several toes completely using light blue make-up. Using a small paint brush, create a blue tinge on the victim's lips and toenail beds. Apply frostbite wounds to nose and hands of victim. Place victim on the ground, covered in blankets. Using a spray bottle to create a fine mist, coat the top, sides and ends of a wig with water and place in freezer to create icicles. Place wig on victim. Advise patient to shiver and respond intermittently to questions. 

Use in Conjunction With: 

Cyanosis; Skin mottling

Cleanup and Storage:

Advise victim to carefully remove the frostbite wound from their skin, using their fingers to lift the wound around the edges of the Silifex. Using a gentle upward motion, continue to peel away the wound until all Silifex has released from the skin. Using a soft, clean cloth or make-up remover towelette, remove the make-up and any remaining product residue from the skin. Wig can be air dried and stored in moulage box for future use.

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 GapTM 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.