Student Surgical Association of Hong Kong

Suturing Starters' Kit

Welcome to the Suturing Workshops! You must be more than eager to start trying, but here are some information to get started in case you are puzzling about each and every details of the skills.

We would encourage you to go through these materials before participating in the suturing workshops. For non-participants, feel free to use these as learning materials to get a gist of the basic suturing skills!

(For simpler skills like knot tying you can always practice with a piece of thread at home.)

NOTE: There are multiple ways to do a knot. The detailed steps illustrated here may differ from what is taught by your tutor.

Instruments Handling

Instrument Tie

Interrupted Sutures

Hand Tie

General Description

This maneuver is accomplished by first grasping the fixed suture end with the small and ring fingers, while it is being pinched between the tips of the index finger and thumb. By pronating the wrist, a loop forms around the grasped fingers, and the top of the loop must again be grasped between the tips of the thumb and index fingers. The small and ring fingers are then withdrawn from the loop before coiling more suture. The rasped suture can be easily lengthened by releasing the coils held between the tips of the thumb and index finger.

Clinical Significance

The value of instrument ties has become readily apparent in special situations in which hand ties are impractical or impossible. In microsurgical procedures, an instrument tie provides the most reliable and easiest method of knot construction. When employing suture in the recesses of the body (e.g. mouth, vagina, etc.) or during endoscopic surgery, instruments can also form knots in sites to which the hand could never gain access

Gives and Takes

When tying knots with an instrument, it is difficult to apply continuous tension to the suture ends. Consequently, widening of the suture loop due to slippage is frequently encountered in wounds subjected to strong tension. This technique, however, is ideally suited for closing a wound which is subjected to weak tensions. In this circumstance, instrument ties can be accomplished more rapidly and accurately than hand ties, while conserving considerably more suture. By using this technique, the parsimonious surgeon can complete 10 interrupted suture loops from one suture measuring 18 inches in length. This feat would be impossible if the knots had been tied by hand.

A simple interrupted suture technique is useful for easy closure of traumatic and surgical wounds. Begin by entering the skin with the needle at a 90° angle to the skin. Full-thickness tissue bites encompass the epidermis and dermis. The first throw of the knot is a surgeon’s knot, and all subsequent knots should lie squarely on the previous knot. The sutures should be spaced close enough to coapt the tissues but not cause ischemia. Text and illustration:

One-hand and Two-hand techniques

Hand tying of knots can be accomplished by either the two-hand or one-hand technique. Each technique has distinct advantages as well as drawbacks. The two-hand technique of knot tying is easier to learn than the one hand. An additional advantage of the two-hand tie is that the surgeon can apply continuous tension to the suture ends until a secure knot is formed. With the one-hand method, it is often difficult to maintain tension on the suture ends during the formation of the knot and slippage of the first or second throws will be encountered, especially by the inexperienced surgeon.

General Description

Using the two-hand technique, one constructs the knot predominantly with his/her left hand, which forms a suture loop through which the free suture end is passed. The left hand continually holds the suture end until knot construction is complete. In contrast, the right hand merely holds, lets go, and regrasps the free suture end. If the surgeon inadvertently manipulates the fixed suture end with his/her right hand, he/she will be passing either the needle or reel through the formed loop. The latter case is an invitation to needle puncture.

Hand Dominance Matters

Many right-handed surgeons prefer to manipulate the free end of the suture with their left and during two-hand ties. In such cases, the right hand performs the major manipula-tion of the suture during formation of the loop. An advantage of this hand tie technique is that a surgeon who ties his/her own knots by the two-hand technique during wound closure can hold the needle holder in his/her right hand during knot construction. If one desired to learn to tie knots using the left hand to manipulate the free end of the suture, study illustrations in a mirror.

Advanced Readings and citation reference

Unless otherwise specified, all the information selected above is cited from the following material:

Last updated: March 4, 2015