Although needle holders are often held in the thumb and ring finger, some prefer the palm grip, enabling good control as the wrist is turned
Load the needle in the holder about two-thirds of the way along the curve
Sutures should be inserted fairly close to the wound edge, approximately 2 mm, making sure it is the same on both sides
The skin must be handled gently and elevated using a skin hook or one edge of a pair of forceps - where possible the skin should not be held between a pair of forceps
Insert the needle at 90 degrees to the skin surface and advance using wrist movement. The skin on the other side of the wound must be entered at the same level that the needle exits
The square knot must be used
It is preferable to start with one suture at either end of the wound and work inwards – avoid putting a suture too close to the apex of the wound as it will create a dog-ear
Sutures should be equally spaced, using the fewest number to achieve wound closure, although the thinner the skin the closer together sutures should be placed, alternatively combine with mattress sutures
