Wound of the Month: Krokodil

Objective: Using moulage to create a realistic Krokodil wound. (see Figures 1 and 2)

Time:

5-7 minutes

Skill Level:

Advanced

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

• Setting powder, translucent
• Latex, clear
• Wax, light flesh
• Color stix, white
• Color stix, green
• Color stix, black
• Caramel color

Equipment:

• Stipple sponge
• Make-up sponges
• Paint brush, small
• Toothpick
• Blow dryer

Technique: (see Figure 3)

Using modeling wax tools or your fingers, create wound depth by spreading wax over desired krokodil site, creating a large, thin layer, approximately 4x3 inches in diameter and 1/8" thick. (see Figure 4) 

Using a stipple sponge, create wound texture by firmly pressing the sponge into the surface of the modeling wax, using a blotting or up and down technique. Continue to blot surface of wax until completely covered and multi-dimensional. (see Figure 5) 

Using clear latex, lightly coat surface of modeling wax, ensuring all topical areas and texture pockets are completely covered. Using a blow dryer on low-cool, gently dry the latex until set, approximately 1 minute, or allow to air dry 2-3 minutes and dry to the touch. (see Figure 6)

Create skin discoloration by using a make-up sponge or paint brush that has been dipped in white make-up and lightly blotting the surface of the modeling wax and victim's natural skin. 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 7)

Using a make-up sponge that has been dipped in green make-up, create secondary discoloration by lightly applying colorant over areas of the modeling wax using a gentle blotting motion. Again, 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 whitened skin and natural skin color to show through. (see Figure 8)

Using a small brush that has been dipped in black colorant, create small areas of eschar along the raised pockets, inside fingers and over larger flat areas of the skin. (see Figure 9)

Using a stipple sponge, apply a light coat of translucent powder along the edges of the latex and along the areas of natural skin. (see Figure 10) 

Using a toothpick, create krokodil texture by carefully lifting the modeling wax and latex from the skin. At a 45 degree angle, insert the tip of the toothpick under the latex and wax material, until the toothpick is parallel to the skin. Gently lift wax and latex, straight up, stopping short of breaking the fibers.  Gently return to the toothpick back down to the skin and remove from under the latex. Continue to repeat under large area of skin has become three-dimensional. (see Figure 11)

Using a paint brush that has been dipped in green colorant, apply additional colorant to areas of exposed skin under the texturing and ridges of textured pieces. Add additional colorant and or powder as desired.

Training Scenario:

Dispatch: Medic 12, Respond Code 3 to 98 4th Street; Jesus Center, victim non-responsive. Unknown injuries. Nearest cross street, Bryant Road. Butte County Fire responding. 1715 hrs. Dispatch clear.

On Scene: Using a make-up sponge, apply white make-up to the face of victim, blending well. Using a small paint brush that has been dipped in blue make-up, create under-eye circles by lightly applying colorant from the inside corner of the eye to approximately 2/3 across, and blot lightly to blend. Create an appearance of dishevelment by tussling the hair, wrinkling the clothes and untying one of the shoes. Using black make-up and blood mixture, create small open sores to the skin of the victim. Apply krokodil wound to back of hand extending from fingers, between thumb and reaching to middle of hand. Place victim slumped in the bathroom, with an empty hypodermic syringe on the floor.    

Use in Conjunction With:

Sweat; Vomit

Cleanup and Storage:

Advise victim to carefully remove the krokodil wound from their skin, using their fingers to lift the wound around the edges of the latex. Using a gentle upward motion, continue to peel away the wound until all latex has released from the skin. Using a soft, clean cloth or make-up remover towelette, remove the wax, make-up and any remaining product residue from the skin. 

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.