Medical Monday; Agony of the Feet (infected plantar wart)

Time for another Medical Monday! And the obligatory trigger warning:

So this is Sim Man (well, ALS Man), one of our high-fidelity patient simulators. Or Slightly Sinister Robot-Man, if you prefer. We've started doing regular monthly Insitu training on Surgical post-op with this chap, and one of the scenarios we were asked to help with was dealing with an older patient with an infected foot wound. Essentially, a Plantar Wart (verruca, for you non-medical types) which had become infected and turned into an open, ulcerated wound.

Here's one I prepared earlier; this one on the heel of the foot. Used a spare foot from the odds and ends box, and a hole cut into the skin, an extra layer added on the inside, and then a soldering iron and hot-glue to mank-up the layer for some texture. The layer on the inside was quite thick (but it didn't matter, as it was going on a custom-designed mannequin). For this new model, apart from the fact the wound needed to be on the toe, the inner layer would need to be thinner to go over the plastic inner foot of the robot. 

Yeah, that thing in the bottom of the picture. It's curiously disturbing, isn't it? I don't think Sim Man is going to be getting much trade on his OnlyFans page with those toes.

The plan was to cut a hole in the base of the toe, then have an inner layer to use as the foundation for the wound. I initially tried using some spare 3mm-thick neck skins for the inner, but these were still a bit too thick for the foot to go over that plastic former...

...but I then found, in the materials cupboard, some more bits of a popped beach ball (having previously used the transparent red vinyl for making some simulated pooled blood). I was having trouble working it into the toe though, and pulling it into place from the inside. If only I had some sort of long forcep-like tool to pull it through from the inside...

Oh wait, that's right, I work in a lab full of more instruments than I can count.

The edge of the wound was chamfered and cut with a size-22 scalpel, then the vinyl was fitted in place, and the whole lot washed over with superglue and left to set.

Hot glue was used to make a border around the wound (to represent peeling flesh around the wound), and some slivers of the spare latex skin from the removed patch glued inside for texture . Once again, Warhammer paints used to colour it all...

...and fake blood washed over the wound, to give it a glossy look.

Raiding the make-up kit for reddening around the wound, and we also had some simulated pus to mix in before the wound was dressed.

Yeah, all it's missing is the rank smell (and we did indeed try to simulate that too).

And here he is, ready for the Sim. The wound was wrapped up and bandaged (as if the patient himself had done it), so it was a bit sticky and gunky when the examining candidate peeled the dressing off. Lovely stuff- and best of all, it's re-usable for future sims.