How to Suture
- Wash your hands for at least 20 seconds with soap and water. Dry hands
- The wound should be irrigated copiously with normal saline (preferably) or tap water. Irrigating the wound removes foreign matter and dilutes bacterial concentration. This helps reduce infection rate.
- Povidone-iodine solution and hydrogen peroxide, and cleaning products with detergents are not recommended as their toxicity can impede healing.
- Visible foreign matter should be removed with forceps.
- Local hair should be clipped to avoid wound contamination. Do not shave the hair.
- Apply local anesthetic. Allow 30-60 seconds for the anesthesia to begin working.
- Gather a sterile kit.
- Place sterile kit on clean, dry flat work surface. Open outside cover away from body to avoid contamination.
- Sterile kit should contain the following: tissue forceps, scissors, needle holder, needle with thread, and gloves.
- The suture size is dependent on the location of the laceration. A 3-0 or 4-0 suture is optimal for the trunk, 4-0 or 5-0 is ideal for extremities and the scalp, and 5-0 or 6-0 is ideal on the face. For the scalp use a blue suture to differentiate the suture from the hair.
- With the needle holder, take out the needle from its package and attach to needle holder. The needle holder should “click” to indicate the needle is secured in place.
- Hold the needle by its flat side using the needle holder
- If you are right-handed, hold the needle holder with the right ring finger and thumb. To assist with control and stability, place index and middle finger along the side of the needle holder. Hold the tissue forceps with the left hand. These tools will be held opposite if you are left-handed
- Tissue forceps should be held like holding a pen.
- Holding the needle holder with needle, begin suturing in the middle of the wound by piercing the skin at a 90-degree angle from outside to inside. Twist your wrist half a circle clockwise so the trailing suture follows the curve of the needle. Pierce the skin 0.5cm down from end of the wound.
- Release the needle holder’s “click” using your ring finger and thumb to push the device to the left. This will release the needle, allowing you to pierce the wound.
- Puncture the opposite side of the wound as you did in the step #10 except go inside to outside.
- Pull the suture through, leaving 2-3 inches behind
- Release the needle from the needle holder
- Use your opposing hand to hold the suture and wrap two to three times clockwise around the closed needle holder.
- Grab the tail of the suture with the needle holder to pull through and make a knot. Place knot to side of the wound, never on top of the wound.
- Be mindful of pulling too tight. Only pull enough to seal the sides of the wound.
- Cut the tail off the suture leaving 0.5-1 inch.
- Continue placing the remaining stitches symmetrically using the steps above until the wound is closed
- Cover with dry dressing after closing the wound.
Forsch RT (2008). Essentials of Skin Laceration Repair. Am Fam Physician [online];78(8):945-951. Accessed December 31,2020.