Mr Jonathan Cubitt

Developing a realistic burns surgery simulator to improve emergency care

When someone suffers a deep, circumferential burn to a limb, it can act like a tourniquet, cutting off blood supply and putting the limb at risk. The emergency surgery to release this pressure is called an escharotomy, and it needs to be done quickly — sometimes before a patient even reaches a burns centre.

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But until now, there has been no realistic way to practise this critical procedure. Most surgical trainees only learn about it theoretically, without hands-on experience. This project set out to change that.

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What this project set out to explore

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With support from a Blond McIndoe Pump Prime Award, burns and plastic surgeon Mr Jonathan Cubitt led the development of a high-fidelity surgical simulator to train doctors in performing upper limb escharotomies.

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Working with colleagues at the Welsh Centre for Burns and Plastic Surgery and Swansea University, Mr Cubitt created a reusable limb model using CT scan data and silicone layers. The model includes a replaceable skin layer, realistic fat that bulges when cut, and a fingertip that changes colour when blood flow is successfully restored — giving instant visual feedback.

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What the team found

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The model was tested with 34 surgical trainees — including both plastic and general surgeons. Participants practised the procedure using the simulator and completed surveys before and after the training. All groups reported significantly increased confidence in recognising when to perform an escharotomy, how to plan and execute the procedure, and how to manage aftercare.

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These results suggest that the simulator is a valuable teaching tool — particularly for non-burns surgeons who may need to perform the procedure in an emergency, before a patient can be transferred to a specialist unit.

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Why this matters

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Burns affect more than 250,000 people in the UK each year, and time-critical procedures like escharotomy can make the difference between losing or saving a limb. This simulator offers a safe, realistic way for surgeons to develop the skills they need before facing a real emergency. It’s also portable and reusable, making it ideal for training in resource-limited settings around the world.

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The wider impact

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As Mr Cubitt explains:

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“The BMRF pump priming award enabled me to develop a high fidelity simulator for emergency escharotomy for severe burns. This project would not have been possible without the funding that I have received. With the simulator, I have developed a training course for senior surgical trainees (general surgery and plastic surgery) to optimise their training in a life and limb saving operation and have demonstrated the validity of the training. This has meant that there is a cohort of surgical trainees who are now better equipped in terms of emergency burns surgery. This simulator model and training course will hopefully act as a stepping-stone for a more comprehensive emergency burns training course involving more high fidelity simulators that will improve the delivery of burns care in the UK and possibly globally.”

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“Personally, this project has been an excellent opportunity to translate the skills that I have learnt as a burns surgeon into training opportunities for other surgeons.”

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The research was presented at the British Burn Association (BBA) conference and submitted to the journal Burns for publication.

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Next steps

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Mr Cubitt is now applying for additional funding to expand the training course and develop further simulators — including models for chest escharotomy, lower limb release, and emergency tracheostomy. These tools will form the basis of a comprehensive emergency burns course to improve surgical training and patient outcomes both in the UK and worldwide.