This document provides guidance on basic surgical skills for knot tying, suturing techniques, and common errors. It describes knots like the reef knot and surgeon's knot and how to orient knots. Suturing techniques covered include simple everting and buried sutures, subcuticular suturing, vertical and horizontal mattress sutures, barron sutures, and purse-string sutures. Steps are outlined for how to perform each suturing technique. The importance of practice to improve skills is emphasized. References are provided for additional information.

1. Basic Surgical Skill Course
Hospital Seberang Jaya
9 2013
Prepared by Dr. Michael P.K. WONG & The Surgical Team

2. Surgical Knotting Guides

3. Reef Knot***

4. Granny Knot

5. Surgeon’s Knot***

6. Orientation & Security of Knot
(Laid-down)
180

7. Orientation & Security of Knot
(Sliding Half-Hitch)
90

8. How to Do Instrument Knot?
(1)

9. How to Do Instrument Knot?
(2)

10. How to Do Instrument Knot?
(3)

11. How to Do Instrument Knot?
(4)

12. How to Do Instrument Knot?
(5)

13. How to Do Instrument Knot?
(6)

14. How to Do Instrument Knot?
(7)

15. How to Do Instrument Knot?
(8)

16. How to Do One-Handed Knot?
(1)

17. How to Do One-Handed Knot?
(2)

18. How to Do One-Handed Knot?
(3)

19. How to Do One-Handed Knot?
(4)

20. How to Do One-Handed Knot?
(5)

21. How to Do One-Handed Knot?
(6)

22. How to Do One-Handed Knot?
(7)

23. How to Do One-Handed Knot?
(8)

24. How to Do One-Handed Knot?
(9)

25. How to Do One-Handed Knot?
(10)

26. How to Do One-Handed Knot?
(11)

27. How to Do One-Handed Knot?
(12)

28. How to Do One-Handed Knot?
(13)

29. How to Do One-Handed Knot?
(14)

32. How to Do Aberdeen Knot?
(1)

33. How to Do Aberdeen Knot?
(2)

34. How to Do Aberdeen Knot?
(3)

35. How to Do Aberdeen Knot?
(4)

36. How to Do Aberdeen Knot?
(5)

37. How to Do Aberdeen Knot?
(6)

38. How to Do Aberdeen Knot?
(7)

39. How to Do Aberdeen Knot?
(8)

40. Basic Suturing Guides

41. Simple Suturing - Everting
• A>B
• Correct suture
placement produces
accurate edge to edge
contact and the wound
appears slightly everted
• Eliminate dead space
A
B
Angle must
be >90

42. How to Do Simple Suturing?
(1)

43. How to Do Simple Suturing?
(2)

44. How to Do Simple Suturing?
(3)

45. How to Do Simple Suturing?
(4)

46. How to Do Simple Suturing?
(5)

47. Simple Suturing - Buried
• To close dead space
• Facilitate in wound
healing and prevent
infection
• Usually used at
subcutaneous tissues
• Followed by
subcuticular or simple
interrupted sutures

48. Subcuticular Suturing

49. How to START Subcuticular Suturing?
(with Absorbable Suture)

50. Subcuticular Suturing
Epidermis
Dermis
The suture should be between Epidermis
and dermis, not within the epidermis

51. Subcuticular Suturing
Correct
Alignment X

52. Subcuticular Suturing
Correct
Alignment
x

53. How to START Subcuticular Suturing?
(with NON-absorbable Suture)

54. How to End Subcuticular Suturing?
(with NON-absorbable suture)
Tied over the wound
Tied to itself at the ends
Secured with crimpled
beads at both ends

55. Vertical Mattress Suturing

56. How to do Vertical Mattress Suturing?
(1)

57. How to do Vertical Mattress Suturing?
(2)

58. How to do Vertical Mattress Suturing?
(3)

59. Horizontal Mattress Suturing

60. Horizontal Mattress Suturing

61. Common Errors with Horizontal
Mattress Suturing
X
Knots Too Loose

62. Common Errors with Horizontal
Mattress Suturing
Knots Too Tight
X

63. Barron Suture

64. Three-corner Suture
This is a Variant of the
Barron Suture

65. Purse-String Suture
• continuous stitch
paralleling the edges of
a circular wound
• wound edges are
inverted when tied
• used to close circular
wounds

66. Practise Makes Perfect

68. References
• Skinner, I. 2000: Basic Surgical Skills Manual, chapter 4, pp.
116-144. The McGraw-Hill Companies, Inc., Australia.
• WEG Thomas et.al., 2002: Intercollegiate basic surgical skills
course participant handbook, 3rd Edition, Module 1 , pp. 26-
27. The Royal College of Surgeons of England, London.
• www.cartoonstock.com