Position of the suture needle in the needle holder

Half and half suture technique

Tying the suture knot
This station is written to demonstrate one method of
suturing. There are, however, other techniques that, for
example, do not start in the middle of the wound and
that advocate tying the knot differently. There are still
other methods that allow you to use your hands to
handle the suture needle. It is important that you check
with your own medical school syllabus or clinical skills
centre what techniques they suggest and follow them,
as this will be what you face in your exam.

Tetanus

Human anti-tetanus immunoglobulin (HATI)

should be given instead if the patient has a history of
severe reactions to tetanus vaccine.
Examples of tetanus-prone wounds include:
Those contaminated with soil or manure
Those harbouring infection or with a wound more
than 6 hours old
Puncture wounds, for example from nails or bites

Immunisation status

Prophylaxis required

Full course of five

injections, or booster
within the last 10 years

Clean wounds need no prophylaxis

HATI can be given for tetanusprone wounds contaminated
with manure
Tetanus booster should be given
to all wounds
HATI should additionally be given
for tetanus-prone wounds
Start tetanus course for all wounds
If tetanus prone, additionally give
HATI

Partial course, or booster

more than 10 years ago

Unknown status, or
non-immunised

Hints and tips for the exam

You will be asked to suture a slab of sponge or fake
skin. A piece of chicken is sometimes used. In either
case, the principle is the same.
The wound is typically straight and just 12cm long.
In a 5-minute station, it is unlikely that you will be
asked to close the entire wound but instead to perhaps
produce one or two sutures.
You must say you would position the patient comfortably. This is often supine or semi-reclined, with the
part to be sutured well supported.
Show the examiner your aseptic technique.
You may need an assistant in preparing your equipment, for example to pour the cleaning solution into
your pot, but it is likely that, in 5-minute stations, this
will already be set up for you, and you will just need to
check that everything is there.
Clean and wash the wound thoroughly before closure.
If there is dirt or foreign matter, say that you would
thoroughly irrigate the wound.
The wound should be cleaned with sterile solution
before local anaesthetic is given.
Be generous with the amount of local anaesthetic
because if the patient feels pain, they will tense their
muscles and this can interfere with wound closure.
However, take care that your local anaesthetic does not
distort the wound edges.
Infiltration of local anaesthetic should be from the
outside inwards; do not forget the very edges and angles
of the wound.
Leave 1cm of thread so that suture removal is easier.
Do not leave the knot in the middle of the wound.
Ensure there is no tension in opposing edges, and that
the knot is not so tight as to cause pressure on the skin
that it is holding.
Document the number of sutures you have inserted
so that, on removal, it can be ensured that all the
stitches are out.
Practise in your clinical skills centre as suturing
without handling the suture needle is a difficult task
until you have done it many times.
Always mention tetanus.