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1 Health Sciences Module: Healing Skin and Suturing Pathways to Prosperity Network
HEALING SKIN AND SUTURING
Essential Question: How Does Skin Heal?
Learning Targets:
Students will:
● Objectively summarize informational text.
● Use a variety of media to develop and deepen understanding of a topic or idea.
● Compare the functions of the three layers that make up the skin.
● Use new knowledge about how a wound heals to reflect on common first aid practices.
● Practice suturing on a model.
● Collaborate as a team member to practice a high-value study skill.
Lesson Overview
In this lesson, the skateboard accident victim is treated for his facial laceration. Young Physician
Assistants participate in a laboratory exercise that is frequently used by physicians to practice
their suturing skills, the Banana Suture Lab. A Gallery Walk of students’ attempts to suture is
designed to give them a chance to find humor in their work. Students also engage with short
informational texts to construct an understanding of skin as an organ of the body and how
wounds heal. Students will answer the question: How does skin heal?
2 Health Sciences Module: Healing Skin and Suturing Pathways to Prosperity Network
Lesson Agenda
Opening (5 min) o Emergency Scenario
Work Time o How Does Skin Heal? (20 min)
o Suturing Skills (30 min)
o The Skin I’m in (20 min- optional)
Closure (10 min) o Take a Stand (5 min)
o Stars and Stairs (5 Min)
Materials
□ Young Allied Health Professional student packet
□ Projector, speakers (for videos)
□ How Wounds Heal (video to project)
□ Suturing a Wound (video to project)
□ Suturing a Banana Lab (one per pair of students)
□ Banana (1/2 per student)
□ Dental floss (approx. 10 inches per wound)
□ Curved needle
□ Forceps or tweezers (if needed to pull skin away from wound)
□ One knife (a butter or kitchen knife is fine, for preparing the bananas. This is for
teacher use only.
□ Banana Suture Lab (video to project)
□ Materials for skin grafting extension (optional)
FACILITATION NOTES
The Narrative Arc. The more each <Emergency Scenario> can be presented as if telling a
story, the more engaged the audience will be. Work to avoid a stale reading and lean towards
bringing the information to life as in a conversation or a “reveal” of the next chapter. Think of
creative ways to make the story your own.
Safety. Take time to establish procedures and norms for lab safety prior to conducting the labs
in this unit. This lesson contains a lab that requires the use of sewing needles. Set the
3 Health Sciences Module: Healing Skin and Suturing Pathways to Prosperity Network
expectation that the young allied health workers will take lab experiences seriously and behave
in a professional manner. With sharp materials, the first time a student acts inappropriately or
unsafely, they will lose the privilege of participation. Take their needle and let them observe.
Ensure they understand this “one strike, you’re watching” approach before receiving materials.
Material Preparation. Consider preparing “suture stations” that are ready to distribute to the
young allied health workers. This preparation will allow the class to remain fluid, encourage
engagement, and lower classroom management issues.
Material Distribution. With any materials that are sharp, take care to have accountability in
distributing and collecting the needles. Consider using a checklist to ensure all needles are
returned. If you choose to suture a pig’s foot rather than bananas, you can find a lab exercise at
http://www.haspi.org/curriculum-library/A-P-Core-
Labs/Integument%20System/Labs%20&%20Activities/Lab%20-%20Suturing.pdf.
Bananas. Prepare your bananas before class. There will be an excess of bananas after this lab.
Consider composting them.
Stitches. Find this interesting or would like more background information?
See: http://www.slideshare.net/obgynramamahidol/basic-suture-materials-and-needles.
Take a Stand Protocol. This protocol encourages reflection and finding nuance along a 0-100
gradient of “important to me” to “not important to me.” See a variation of this protocol at
https://vimeo.com/101559969. In this application, students are not trying to convince others,
though you might encourage them to share why they selected their stance.
Extension. As an extension, consider exploring another operation for healing skin: skin grafting,
or a surgical operation in which a piece of healthy skin is transplanted to a new site on the body
(https://www.youtube.com/watch?v=l83DndvIfV4). To help students understand what can be
involved in this operation, have them build a model of the skin. You can reference the following
lesson if you plan to run this activity: http://www.meetpenny.com/2013/03/science-saturday-a-
model-of-the-skin-lesson-
12/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed:+MeetPenny+%28Meet
+Penny%29&utm_content=Google+Reader.
4 Health Sciences Module: Healing Skin and Suturing Pathways to Prosperity Network
IN ADVANCE
□ Try the Banana Suture Lab yourself so that you know how to help students when they
complete the lab.
□ Pre-assign lab partners.
□ Preview the Suturing a Wound video that can be found at
https://www.youtube.com/watch?v=e1jThI5wbVw. This video shows a doctor suturing an
actual wound. The first minute gives key information (to 1:09). Then the video shows a
doctor suturing, which may be too graphic for some audiences, but could be shown to
interested students as an extension.
□ Preview the two types of stitches:
□ Continuous stitches: https://www.youtube.com/watch?v=LFzkH6U_M5c.
□ Interrupted stitches: https://www.youtube.com/watch?v=_PH-Hzz6ixY.
□ Ensure technology is in place for the lesson (projector, speakers, etc.)
Vocabulary
Content Tier II
suture, anesthetic, irrigate, saline,
epidermis, dermis, subcutaneous, melanin,
hypodermis
continuous, interrupted
Opening (5 min)
Emergency Scenario
In the emergency room, the patient is placed in the hands of an emergency room team—
including you! You are a physician assistant—or P.A. You work in the emergency room and
perform many of the same tasks as a doctor, particularly for issues that are more routine. You
chose to become a P.A. because you liked the excitement of the emergency room and can stay
focused under pressure. You started as an EMT yourself, gaining experience in the field before
applying to be a P.A. At first, you thought about becoming a doctor, but then learned about the
role of a physician assistant. Your program was 2 years long—a fraction of the 11-16 years it
would have taken you to become a doctor. These years were still hard work, requiring focus,
5 Health Sciences Module: Healing Skin and Suturing Pathways to Prosperity Network
persistence, grace under pressure, and excellent study skills. Now you are part of an allied
health team that supports patients as they enter the E.R.
Today you get to practice suturing, or giving stitches.
1. Ask: Who here has received stitches?
2. Have the young professionals turn to a colleague and share any personal stories they
have about being in surgery, needing stitches, and/or having scars.
3. Share the next chapter of the story by reading or acting out: <Emergency Scenario:
Facial Laceration Treatment>
Work Time
How Does Skin Heal? (20 min)
As a PA, it is important to know not only the structures and functions of the body, but also
about the healing process. As we learn about how the skin heals, think about
how bones heal. What are the similarities and differences? As you watch the
video, think about what the healing process will mean for the treatment of your
patient.
Project: https://www.youtube.com/watch?v=TLVwELDMDWs
Now we are going to read and review with a powerful study strategy.
Spider Map: Read, Recall, Revisit Protocol
1. Distribute the <How Wounds Heal Text>.
2. Project the image of the Spider Map.
3. Ask: What is the concept that is represented by the center circle?
4. Use equity sticks to choose randomly. Listen for: How a wound heals.
5. Model writing the heading into the center circle of the Spider Map.
6. Explain to the young professionals that they will follow a Read, Recall,
Revisit protocol.
o First they will read about stage one: bleeding.
Self-quizzing is a high-value
study strategy. Hundreds of
experiments show that
quizzing improves learning.
Self-quizzing as a strategy
has more evidence of
effectiveness than the
strategies of highlighting,
rereading, and summarizing.
Recall for self-quizzing shows
up to 80% recall versus 30%
for “review.” One theory is
that the process of self-testing
results in a mental search that
includes accessing our long-
term memory, forming
multiple mental pathways that
end up making the
information easier to find.
Out of a meta-analysis of over
700 studies, self-testing made
the top ten study techniques.
6 Health Sciences Module: Healing Skin and Suturing Pathways to Prosperity Network
o Next, they will cover the reading and collaborate as a group to recall as many facts
as they can. Each fact will be written on the “spider legs.”
o Finally, they will revisit the reading and add any facts they missed.
o Repeat for all four stages.
7. Offer to project the video a second time, if YP would like to add to their notes.
8. Conclude: Turn to you neighbor and share a time you had a wound and if you recall it
progressing through these stages.
9. Discuss as a whole class: Based on the healing process, what insights do you have that
would help a wound to heal?
Suturing Skills (30 min)
Banana Suture Lab
Your training as a physician assistant included a lot of time studying human anatomy and
physiology. You know a lot about the skin as an organ of the body and how to suture, or stitch
up, lacerations, or cuts in the skin. (Display the definitions of suture and lacerations up on
board.) You are a perfectionist with your sutures and practice at home to make your sutures
even better to reduce any scarring. As you practice, remember that a health professional
spends hours practicing—expect to make mistakes on your first attempt.
Before suturing, the wound must be cleaned thoroughly. For large lacerations,
stopping the bleeding would be the first priority. Which ABC would this fall under?
After bleeding is under control, and for smaller wounds before bandaging or suturing,
cleaning the wound is important. Why is this?
1. Explain to the young professionals that they will be watching a short video
about how to suture a wound.
2. Tell the young professionals to record any important things to remember
about doing quality suturing.
o For example, the needle should enter the skin at a 90-degree angle.
3. Project the <Suturing a Wound> video:
https://www.youtube.com/watch?v=e1jThI5wbVw
o Invite volunteers to share the important facts with the class.
It is very important to
record the distribution of
needles before the lab
and again at the end of
class. Make certain
students know you have
a list of who has the
needles and who has
returned them—as
facilitator you are
responsible for ensuring
all sharps are returned.
Any safety violation
results in sitting out.
This is an important tone
to set, and important to
enforce calmly and
consistently.
7 Health Sciences Module: Healing Skin and Suturing Pathways to Prosperity Network
o Write them on the board as they are called out.
4. Invite the young professionals to join their lab partner.
o These are pre-assigned.
o Remind them that professionals work with all kinds of people. They are expected
to be respectful and professional as they collaborate with colleagues.
5. Project the <Banana Suture Lab> videos.
o Interrupted stitches: https://www.youtube.com/watch?v=_PH-Hzz6ixY.
o Continuous stitches: https://www.youtube.com/watch?v=LFzkH6U_M5c.
You are now going to receive your professional tools for the lab. These include a
sharp instrument, and I will record who has received them. To leave class, you will
need to return your equipment and be checked off. You have one chance to
use your equipment correctly—especially the needle. If these needles are
used for any other purpose—as toys or in an unsafe way—you will need to
sit this lab out. There is NO second chance.
6. Distribute the materials for the <Suturing a Banana Lab>.
o Remind them of the expectations for safety and responsible use of
materials.
o Record distribution of needles (and check them in at the end of
class).
7. Invite the young professionals to follow the lab instructions they viewed in
the video. Project the video again in the background as students begin to
work.
o When the group completes the lab, invite the young professionals to
display their work. Consider having them label their banana with their
names: P.A. ______.
8. Consider taking pictures of their work to add to the Gallery Walk.
This hands on lab is an
opportunity to emphasize
the growth mindset.
Professionals practice for
many hours to become
competent—most allied
health careers have
extensive labs and
practicums as part of
their training. As you
circulate, encourage a
growth mindset,
reminding YPs they can
always “start over” from
where they are. Remind
them that this is their first
attempt when they
experience frustration,
normalizing how
challenging it can be.
The banana turns black
and shows tears if
stiches are too tight; their
“patient” is giving the YPs
immediate feedback!
8 Health Sciences Module: Healing Skin and Suturing Pathways to Prosperity Network
The Skin I’m in (20 min- optional)
1. Distribute the <Layers of Your Skin> text with the Skin Layers Anatomy diagram.
2. Assign each group one of the layers of the skin:
o Epidermis is the top layer of the skin, or the part of the skin you see.
o Dermis is the second layer of the skin. It's much thicker and does a lot for your
body.
o Subcutaneous Fat is the bottom layer.
3. Distribute note cards to students to jot down key points for their presentations.
4. Explain: First, working with their team, the young P.A.’s will script a brief introduction of
their skin layer, along with the main functions of each layer. Second, they will create a
simile for their skin layer, which will help them process the function. The simile compares
their skin layer to something that has a similar function, allowing them to evaluate and
compare functions of two different objects.
o The epidermis is like a ______ because_________.
5. Using equity sticks, select one member of the group to “introduce their layer” and
another to share their simile.
Closure (10 min)
Take a Stand: Applying Your Lenses to the Physician
Assistant Career (5 min)
Share the “Take a Stand” protocol. A) After each statement is read, you will line up
on a continuum based on how important the statement is to you. B) One end of the
room is very important, the other not important—think of it as a 0-100 space where
you can fill in all of the quantities in between. C) As each statement is read, reflect on
how important each idea is to you and line up accordingly—fill in all along the line to
reflect gradations of importance.
Read the following statements aloud.
The value of this activity
is not for students to
determine if the PA
career “is for them ,” but
rather to begin to
understand their own
values around careers.
By explicitly connecting
the activities of each
lesson to future careers
and opportunities,
students are encouraged
to think with an
exploratory mindset and
in a future-ready way.
9 Health Sciences Module: Healing Skin and Suturing Pathways to Prosperity Network
o After the first sentence, pause and allow students to reflect and select their
stance.
o Once they have settled on the line, share how the statement connects to the
career of PA (second sentence).
SELF
o I am comfortable working around blood, sick and/or injured people. This is part of the work
of a PA.
o I enjoy learning about the human body and doing labs. PAs need many science and
anatomy classes.
o I work well with people. PAs need good bedside manner.
SECURITY
o I like having the ability to work all over the US. There is a growing demand for PAs in many
areas.
o A median pay of $92,970 would offer me the lifestyle I want. That is the median salary for a
PA—those who specialize can earn more!
o I would like to attend 3-4 years of college after high school. PA training is often 3-4 years—
versus 12 or more for a doctor.
SOCIETY
o I am interested in working in inner city/rural communities. Many of these communities do
not have enough access to doctors. PAs help provide medical services to communities
in need.
o I like the idea of a career that helps people. The PA is a healing/helping profession.
Exit Ticket: Stairs and Stars (5 min)
In terms of careers, a physician assistant program takes 2-3 years, and PAs usually have
either an undergraduate degree or hours of experience. Some people go straight into
college to become a doctor. There are many pathways to being in the front line of the allied
health professions, and all of them require focus and the ability to practice a growth
mindset—to learn from each experience in the field. That is why all of these careers require
labs, seminars, and practical experience.
What did you learn from your experience today?
Using your growth mindset, identify two stars (something you did well) and one step
(something you would change or improve the next time).
This is an
opportunity to
connect daily
work to the
growth mindset.
Not only do
professionals
reflect and work
to improve, but
they can also
identify things
they did well.
10 Health Sciences Module: Healing Skin and Suturing Pathways to Prosperity Network
Name:
Date:
HEALING SKIN AND SUTURING: How Does Skin Heal?
Today’s Learning Objectives:
I can: Summarize informational text and use a variety of media to develop and deepen
understanding of a topic or idea.
Use new knowledge about how a wound heals to reflect on common first aid practices.
Practice suturing on a model.
Collaborate as team member to practice a high-value study skill.
I will participate in a laboratory exercise that is frequently used by physicians to practice their
suturing skills, the Banana Suture Lab. I will also engage with short informational texts to
construct an understanding of skin as an organ of the body and how wounds heal. I will answer
the question: How does skin heal?
Today’s Activities:
Emergency Scenario; How Does Skin Heal?
Suturing Skills; The Skin I’m In; PA Line Up
11 Health Sciences Module: Healing Skin and Suturing Pathways to Prosperity Network
Emergency Scenario: Facial Laceration Treatment
You have just been assigned an operating room to repair a severe facial laceration of a
skateboarding accident victim. As a physician's assistant specializing in surgery, you often
handle many issues a physician does: inserting breathing tubes, surgical drainage tubes,
starting central IV lines, cutting and draining abscesses, as well as working as a part of a
surgeon/anesthesiologist/nursing team. A physician’s assistant can do about 80% of the general
tasks in an emergency room. When something is more complicated, a physician or surgeon is
always available to consult—or step in if needed.
You scrub up as the sterile tech and nurse gather the materials. The patient is wheeled into the
room by a pair of orderlies, or professionals who work in hospitals but do not provide medical
care. They get the boy settled on the operating table. You begin to inspect his wound and find
that it is quite deep and includes some muscle tissue. It is 50.8 millimeters in length, extending
from the side of his nose and through his top and bottom lips. Because this is a serious
laceration on the face, today you will assist an experienced surgeon who will stitch the wound.
The nurse begins to irrigate the laceration with a saline solution. The wound must be cleaned
very well, and flushing it with a salt-water solution reduces the chances of an infection. Because
of the severity of the laceration, the anesthesiologist joins you at the table and begins to
administer general anesthetic, or drugs that are given to a patient before a surgery in order to
help him or her not feel pain.
And, finally, the surgeon is ready to begin suturing the wound. For smaller wounds or stitches
on other parts of the body, you could handle the work yourself. Because of the visibility, depth,
and length of the wound, a surgeon has been called. In addition to stitching the wound, your
team’s goal is to make the sutures perfect so this patient will not have a prominent scar on his
face.
12 Health Sciences Module: Healing Skin and Suturing Pathways to Prosperity Network
How Wounds Heal Wounds heal in stages. The smaller the wound, the quicker it will heal. The larger or deeper the
wound, the longer it can take to heal.
1. BLEEDING
When you get a cut, scrape, or puncture, the
wound will bleed.
The blood will start to clot within a few
minutes or less and stop the bleeding.
The blood clots dry and form a scab, which
protects the tissue underneath from germs.
Not all wounds bleed. For example, burns.
Some puncture wounds and pressure sores
don't bleed.
2. INFLAMMATORY STAGE
Once the scab forms, your body's immune system kicks in
to protect the wound from infection.
The wound becomes slightly swollen, red or pink, and
tender.
You also may see some clear fluid oozing from the
wound. This fluid helps clean the area.
Blood vessels open in the area, so blood can bring
oxygen and nutrients to the wound. Oxygen is essential
for healing.
White blood cells help fight infection from germs and
begin to repair the wound.
This stage takes about 2 to 5 days.
3. TISSUE GROWTH AND
REBUILDING
The body rebuilds tissue and begins to repair
itself.
Over the next 3 weeks or so, the body
repairs broken blood vessels and new tissue
grows.
Red blood cells help create collagen, which
are tough, white fibers that form the
foundation for new tissue.
The wound starts to fill in with new tissue,
called granulation tissue.
New skin begins to form over this tissue.
As it heals, the edges pull inward and the
wound becomes smaller.
4. SCARRING
A scar forms and the wound becomes stronger.
As healing continues, you may notice that the area is
itchy. After the scab falls off, it may look stretched, red,
and shiny.
The scar that forms will be smaller than the original
wound. It will be less strong and less flexible than the
surrounding skin.
Over time, the scar will fade and may disappear
completely. This can take as long as two years. Some
scars never go away completely.
Scars form because the new tissue grows back
differently than the original tissue. If you only injured the
top layer of skin, you probably won't have a scar. With
deeper wounds, you are more likely to have a scar.
Some people are more likely to scar than others. Some
may have thick scars called keloids. People with darker
complexions are more likely to form keloids.
13 Health Sciences Module: Healing Skin and Suturing Pathways to Prosperity Network
Spider Map: Read, Recall, and Revisit
14 Health Sciences Module: Healing Skin and Suturing Pathways to Prosperity Network
Lab: Suturing a Banana
Materials:
Banana (1/2 per student)
Dental Floss (approx.: 10 inches per wound)
Curved Needle
Tweezers/Forceps (if needed to pull skin away from wound)
Procedure:
1. Obtain a banana. This will be your mock patient.
2. Thread your suture material (floss) through your needle. You will need approximately 10
inches of floss per wound—modify as needed. Tie a square knot to hold the material in
place.
3. Grasp the needle with the needle holder using proper holding technique.
Continuous Stitches: Begin your sutures slightly before your wound. Tie a square knot
on your first incision. Continue with a non-interrupted stitch throughout the length of the
wound. Finish with a square knot and cut off excess ends.
Proper sutures will:
Be uniform in distance.
Showcase knots at both ends.
Show tightness in suture material.
Extend the whole length of the wound.
Non-Continuous Stitches: Begin your sutures slightly before your wound. Tie a square
knot on your first suture. Continue with interrupted stitches throughout the length of the
wound. Cut off excess ends.
15 Health Sciences Module: Healing Skin and Suturing Pathways to Prosperity Network
Proper sutures will:
Be uniform in distance.
Showcase knots at both ends.
Show tightness in suture material.
Extend the whole length of the wound.
16 Health Sciences Module: Healing Skin and Suturing Pathways to Prosperity Network
The Skin I’m in: The Layers of Your Skin
From the American Academy of Dermatology https://www.aad.org/dermatol ogy-a-to-z/ for-ki ds/about-skin/the-layers-of- your-ski n
Your skin has a big job to do protecting your body, so it's made to be tough and stretchy. There
is a lot more to this job than it might seem. There are three main layers of the skin.
Epidermis is the top layer of the skin, or the part of the skin you see.
Dermis is the second layer of the skin. It's much thicker and does a lot for your body.
Subcutaneous Fat is the bottom layer.
Epidermis
Your skin's top layer, the epidermis, is super thin on some parts of your body (your eyelids) and
thicker on others (the bottoms of your feet). The epidermis is the layer of skin in charge of:
Making new skin cells: This happens at the bottom of the epidermis. The skin cells
travel up to the top layer and flake off, about a month after they form.
Giving skin its color: The epidermis makes melanin, which is what gives your skin its
color.
Protecting your body: The epidermis has special cells that are part of your immune
system and help you stay healthy.
17 Health Sciences Module: Healing Skin and Suturing Pathways to Prosperity Network
Dermis
A lot happens in the next layer, the dermis. The jobs of the dermis include:
Making sweat: There are little pockets called sweat glands in the dermis. They make
sweat, which goes through little tubes and comes out of holes called pores. Sweating
keeps you cool and helps you get rid of bad stuff your body doesn't need.
Helping you feel things: Nerve endings in the dermis help you feel things. They send
signals to your brain to interpret how something feels (i.e. feels itchy or nice).
Growing hair: The dermis is where you'll find the root of each tiny little hair on your skin.
Each root attaches to a tiny little muscle that tightens and gives you goose bumps when
you are cold or scared.
Making oil: Another type of little pocket, or gland, in your skin makes oil. The oil keeps
your skin soft, smooth, and waterproof. Sometimes the glands make too much oil and
give you pimples.
Bringing blood to your skin: Blood feeds your skin and takes away bad stuff through
little tubes called blood vessels.
The Hypodermis: Subcutaneous Fat
The bottom layer of skin is called the subcutaneous fat layer. This layer plays an important role
in your body by:
Attaching the dermis to your muscles and bones: This layer has a special
connecting tissue that attaches the dermis to your muscles and bones.
Helping the blood vessels and nerve cells: Blood vessels and nerve cells that start in
the dermis get bigger and travel through the rest of your body from here.
Controlling your body temperature: The subcutaneous fat is the layer that helps keep
your body from getting too warm or too cold.
Storing your fat: This fat pads your muscles and bones and protects them from bumps
and falls.
18 Health Sciences Module: Healing Skin and Suturing Pathways to Prosperity Network
The Layers of Your Skin: Similes
Directions: Use the following model to think of a simile for the function of your assigned layer of
the skin.
The ___________ layer is like a _________ because_________.
19 Health Sciences Module: Healing Skin and Suturing Pathways to Prosperity Network
Exit Ticket: Use Your Growth Mindset!
Take a moment to reflect on today and think of two strengths (stars) and one thing you would
work to improve the next time (step).
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