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Completely redesigned for 2018 using thousands of customer's feedback. We made the skin layer tougher and the wounds thinner. 3 layers of high grade theatrical silicone, skin fat and muscles. Over a dozen premade wounds to practice closing. Includes free instructional card and access to manuals and videos as well. This is the ONLY suture pad on sale on Amazon that was made entirely in the United States. You can find plenty of knock offs (all made in China), but we are the original suture pad! Based out of Brooklyn Naval Yard, keeping manufacturing at home.