This technique takes some time to create on the front end, primarily due to the amount of time that needs to be allotted for drying, so preplanning is a must. Also, participants and staff who come into contact with the moulage need to be advised it’s constructed from latex and should be avoided by those with a latex sensitivity.

What follows is a toolkit of supplies and equipment, as well as the basic technique, for creating many different types of wounds.

TIPS & TRICKS

Reference a picture. I’ve found that sometimes a picture of the type of wound I want to construct is helpful, especially when it comes to colors. Using an Internet search engine will help you find pictures of excellent real wounds that can be printed in color and used for examples. Most of the supplies can be purchased at a large retailer, such as WalMart or a craft store like Michael’s or JoAnn’s. Consider shopping online for items you can’t find in your local area.

Use freezer paper. I experimented with many different types of surfaces on which to make the moulage and found that placing the wet caulking on the shiny, plastic-coated side of freezer paper works best. If the moulage sticks to the freezer paper, use the edge of your palette knife to gently ease up the edges. This is sometimes necessary with really thin pieces of moulage.

Buy the right brushes. You’ll need paintbrushes in several sizes. There are sets of brushes in most craft stores that include both round and flat bristles. Sizes vary, but approximate sizes are round 2/0 or 3/0 to a 12 or 14 and round from size 4 to size 10 or 12. A word of caution: Although purchasing really expensive artist’s brushes isn’t at all necessary, purchasing the really cheap ones isn’t a good idea either because the bristles tend to fall out and ruin your moulage. The set I’m currently using contains 25 assorted brushes—both synthetic and natural hair—as well as two foam brushes, and cost around $7.

Keep colors transparent. When painting the dried caulking, it’s best to keep the colors somewhat transparent. This allows for some of the manikin’s skin color to show through the edges and appear to be a bit shiny, as if they’re wet, which most wounds and secretions are.

Don’t weigh it down. In order for the moulage to support an impaled object, the impaled article must be lightweight. Things like nails don’t work well, but if you have the ability to cut just a small piece of the nail or object, they can be used by working the caulking up the object and leaving it clear where it touches. I’ve found that a piece of a clear, plastic, disposable cup works well to simulate a broken glass shard.

SUPPLIES FOR CREATING BASIC WOUNDS

Clear latex caulking

Caulking gun

Freezer paper

Palette knife

Artist’s paintbrushes

Nori (dried seaweed) sheets (for burns)

Black indelible marker

Disposable gloves

Dish soap (yellow, clear or white is best)

Paint palette (plastic)

Toothpicks

Bridal netting, white or off-white

Plastic cup of water

ACRYLIC PAINTS:

Bright red

Celery or olive green

Black

Dark purple

Dark brown or burnt umber

White

Mustard

Skin colors

ADDITIONAL MOULAGE KIT SUPPLIES

Disguise Stix: red, blue, black, white

Fake blood

Glycerin

It Stays liquid adhesive

PROCEDURE

1. Have a very clear idea of the size, shape and texture of your wound or secretion before you begin. If needed, use an Internet search engine to locate images of the wound you want to recreate and print them in color.

2. Lay out the freezer paper, shiny side up.

3. Cut bridal netting the approximate size and shape you want your moulage to be and place flat on the shiny side of the freezer paper.

Bridal netting for laceration.

4. Use the caulking gun to lay out the caulking directly on top of the bridal netting.

Laying out the caulking.

5. Place a drop of liquid dish soap on your gloved finger and smooth out the caulking to create the general shape of your wound or secretion; make sure all of the holes in the bridal netting are completely filled or covered.

Spreading and forming the moulage piece.

6. Create crevices for lacerations, ulcers or gunshot wounds with a toothpick or edge of the palette knife. Making them jagged and the edges a bit uneven adds realism.

Making the indentation for a laceration.

7. Create bumps for an uneven surface. Pushing the caulking into random lumps creates swelling or blisters.

Wet caulking of a gunshot wound.

8. Use your gloved fingers to create an overall uneven texture by swirling or patting the wet surface of the caulking.

Burn.

9. Leave the piece to dry; this can be up to 72 hours depending on the thickness.

10. Once the piece is dry, pull it free from the freezer paper. If there are areas that are still white, turn the piece bottom side up and allow to dry until completely clear.

Dried gunshot wound.

11. Paint with acrylic paints and allow to dry for several hours. I blend colors to achieve the exact shadings I see in the printed picture (or the vision I have in my head). Generally speaking, the more shading you use, the more realistic it will appear when applied. Using a very small amount of paint and brushing it over the caulking results in the best finished appearance. Sometimes thinning the paint with water helps avoid getting too much paint on a piece.

Gunshot wound painted.

12. To create the charred look for a burn, tear a piece of nori seaweed and wet thoroughly. Place on top of painted surface. Add more paint if needed.

Large, full-thickness burn using nori seaweed sheets.

13. When the paint is thoroughly dry, use a gloved finger to apply a very thin coat of caulking over the paint to seal in the color.

Application of final coat of caulking.

14. For emesis, add items that would resemble partially digested stomach contents. Try to avoid actual food as it will decay. One exception is the use of spices. This example uses the centers from an inexpensive silk flower stem and some wide rubber bands, along with a small amount of mixed spices. I’ve also used emptied medication gel caps. The colors are a blend of celery green, mustard and dark brown.

Emesis with the final coat of caulking just applied and ingredients used to construct it.

APPLICATION TO THE MANIKIN

1. Use a brush to apply the adhesive to both the manikin and the moulage piece.

2. If you want bruising around the wound, it’s best to use Disguise Stix before the glue and the moulage. Trying to put the bruising on after the moulage results in a void just outside the edges of the moulage.

3. Allow both to dry until very tacky and no longer wet.

4. Apply to manikin. If the edges are on a very rounded surface, wrapping an elastic bandage around the area for about 15 minutes works well.

5. Just prior to simulation, apply fake blood and/or glycerin sparingly to the top of the wound. A pool of blood can be placed in the hollows of a gunshot wound or a laceration.

6. To remove, simply peel off of the manikin and rinse under cool running water and allow to dry.

7. Moulage pieces should be stored flat and in a single layer. If layered, they must be between the shiny sides of freezer paper and not overlapping, as they tend to stick together and rip when you try to separate them.

8. Clean the manikin’s skin with mild dish detergent and water.



Emesis

FINAL COMMENTS

The durability and low cost of constructing with this method are what makes it a viable option for those who have some of the staffing, budgetary and time constraints our simulation lab has. Some of the moulage pieces constructed with this method have lasted for over five years and have been used hundreds of times. Although this article primarily addresses trauma wounds, the technique is applicable to other types of moulage. Happy moulaging!

Extensive burns with partial amputation.

Finished burn.

Puddle of urine.

Impaled object in eyeball.

Extensive Burns

Eyeball moulage in manikin.

Facial burns.

Electrical burns.