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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.
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Suturing or
sewing during surgery usually serves one of two purposes:
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It securely
closes blood vessels that otherwise might bleed.
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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.
 Most
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.
 Typically,
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.
 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:
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Don't crush
the tissue with the tissue forceps. Crushing injures the tissue and
impairs healing.
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Follow the
curve of the needle.
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Smaller
"bites" tend to give more precise approximation of tissues; larger
bites tend to have more strength.
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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.
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Don't lift the
tissue with the needle. It is not good for the tissue and risks
breaking the needle tip off.
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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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