Operational Medicine Medical Education and Training

How to Suture a Wound

This video was produced by the US Army in 1991 to assist in instructing medical providers in basic suturing techniques.

The video may be freely downloaded.

 
Video Runtime 11.54
8.7 MB wmv
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Suturing or sewing during surgery usually serves one of two purposes:

  • It securely closes blood vessels that otherwise might bleed.

  • It brings together tissues that you want to stay together. For example, following a cesarean section, you will want to suture together the cut edges of the uterus. This will promote healing that is both prompt and anatomically correct.

Suture needle is grasped with a needle holderMost suturing is done using curved surgical needles and a "needle holder" or "needle driver." Normally, the needle is grasped with the needle driver at a right angle to the needle, approximately half-way to two-thirds of the way back from the tip. In special situations, you may want to grip the needle a little closer to the tip, and sometimes you will want to angle the needle a small amount. Don't angle it too much or the needle holder may lose it's grip on the needle.

Push the needle through the tissue using tissue forceps for counter tractionTypically, you will employ tissue forceps to support or grasp the material you are trying to sew. Ideally, you would use the tissue forceps to support the tissue while you drive the needle through the supported tissue. This is the least traumatic way of sewing. In many or most surgical situation (particularly deep in the pelvis), it is not possible to effectively sew in this way and you must grasp the tissue with the tissue forceps before driving the needle through the tissue.

While pushing the needle through the tissue, follow the curve of the needle.After driving the needle through the tissue you wish to sew, push it through or pull it through, following the curve of the needle.

Several important tips to keep in mind are:

  1. Don't crush the tissue with the tissue forceps. Crushing injures the tissue and impairs healing.

  2. Follow the curve of the needle.

  3. Smaller "bites" tend to give more precise approximation of tissues; larger bites tend to have more strength.

  4. When closing incisions, try to match the placement of the needle on one side with the placement of the needle on the other side. Take similar sized bites, and similar placement of the needle.

  5. Don't lift the tissue with the needle. It is not good for the tissue and risks breaking the needle tip off.

  6. If the needle bends, stop sewing, tie the suture, and get a new needle. Needles that have been bent back into position are weaker and more prone to breakage.

 

From OB-GYN 101: Introductory Obstetrics & Gynecology

 

 

 

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