Fundamentals of Sutures, Needles, Knot Tying, and Suturing Technique

Abstract

Suture and needles are the most essential equipment for the surgeon. Their structure and design have evolved thoroughly in the era of modern surgery. Suture varies based on its physical properties including material, construction, absorbability, size, tensile strength, length, and color. Similarly, needles vary in their point type, curvature, strength, length, and color. An array of combinations of sutures and needles has been created with specific surgical tasks in mind. While there is no ultimate suture that will work in any circumstance, certain guiding principles allow the surgeon to choose the best option. Our aim in this chapter is to provide information on the physical properties of suture and needles so that individuals feel comfortable calling for the proper suture for any surgical task.

Suturing is the fundamental technique for closing spaces, accelerating healing, and minimizing scarring. Knot tying and suturing form the foundation for more advanced surgical techniques. Mastery of tying multiple knot types with each hand is paramount for trainees. Proper suturing technique follows the principle of entering tissue perpendicularly and following the curve of the needle to limit tissue trauma. Mastery of suturing requires an understanding of needle orientation relative to tissue and the ability to anticipate where a needle will exit tissue, adjusting body positioning, and an anticipation of the next maneuver in order to efficiently set it up. This chapter provides explanations on the proper application of various knots and types of stitches used for approximating skin and subcutaneous tissue, fascial closure, hemostasis, and gastrointestinal anastomosis. Our aim is to describe the subtleties of suturing and knot tying that have typically been transferred verbally from mentor to mentee and offer methods to practice these techniques.