How to place a suture in 10 easy steps

Grasp the needle holders.
Pick up the needle in your forceps.
Position the needle:
1. Perpendicular to the long axis of the holders.
2. In the tips of the holders.
3. In the middle third of the needle.
4. Nearer the ‘eye’ than the tip of the needle.
Use tissue forceps to stabilise the tissue layer to be sutured.
Put the needle through the tissues; the width of the “bight” should be approximately the thickness of the tissue being sutured.
Drive the needle with a single rotating motion.
Time can be saved by penetrating both sides of the wound in one motion (stabilising the tissue one side first and then the other with your forceps) or, for more accurate apposition, take two bights to complete one suture.
Extract the needle by fully rotating the hand and then grasping the needle – not at the tip, this blunts it – with the tissue forceps or the needle holder.
Pull the suture through the wound; try to do this in one motion.
Tie the knot, and reposition the needle for the next bight.

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