1. Department of Surgical Research and Techniques
Basic Surgical Practicals
SUMMARY OF KNOTTING AND SUTURING TECHNIQUES

2. Department of Surgical Research and Techniques
Basic Surgical Practicals
Knotting techniques
Viennese knot
Surgical knot

3. Department of Surgical Research and Techniques
Basic Surgical Practicals
Viennese Knot

4. Department of Surgical Research and Techniques
Basic Surgical Practicals
Scalpel grips
fiddle-bow holding
pencil holding

5. Department of Surgical Research and Techniques
Basic Surgical Practicals
Use your hand to fix the skin
Fiddle-bow holding!
Straight, long incision 1 2
Use the belly of the blade
Cut epidermis and dermis through sharply 3 4

6. Department of Surgical Research and Techniques
Basic Surgical Practicals
Holding of the forceps

7. Department of Surgical Research and Techniques
Basic Surgical Practicals
Handling the scissors 4 1
The thumb-ring finger grip !

8. Handling the Mathieu needle holder
Department of Surgical Research and Techniques
Basic Surgical Practicals
Handling the Mathieu needle holder
in left hand in right hand

9. The proper position of the needle in the needle holder
Department of Surgical Research and Techniques
Basic Surgical Practicals
The proper position of the needle in the needle holder
1/3
2/3
eye of the needle
tip of the needle

10. Department of Surgical Research and Techniques
Basic Surgical Practicals
Insertion of the thread

11. Simple interrupted suture
Department of Surgical Research and Techniques
Basic Surgical Practicals
Simple interrupted suture
1 cm rule!
the knot is on the side
slow
safe
skin
fascia
muscle

12. Department of Surgical Research and Techniques
Basic Surgical Practicals

13. Department of Surgical Research and Techniques
Basic Surgical Practicals

14. Department of Surgical Research and Techniques
Basic Surgical Practicals

15. Knot tied using Instruments
Department of Surgical Research and Techniques
Basic Surgical Practicals
Knot tied using Instruments

16. Department of Surgical Research and Techniques
Basic Surgical Practicals

17. Department of Surgical Research and Techniques
Basic Surgical Practicals
Suture removal

18. Department of Surgical Research and Techniques
Basic Surgical Practicals 1 2 3 4

19. Department of Surgical Research and Techniques
Basic Surgical Practicals 1 2 4 3

20. Department of Surgical Research and Techniques
Basic Surgical Practicals
Vertical mattress suture (Donati)
wide-wide-close-close
four punctures in the same vertical line
1,5 cm and 1-2 mm
in the subcutaneous layer and superficial
knot on the side
skin
slow
wide and deep and superficial wound closure

21. Department of Surgical Research and Techniques
Basic Surgical Practicals 1 2 4 3

22. Department of Surgical Research and Techniques
Basic Surgical Practicals 1 2 3 4

23. Department of Surgical Research and Techniques
Basic Surgical Practicals
Suture removal

24. Department of Surgical Research and Techniques
Basic Surgical Practicals
Donati suture Allgöwer suture
The thread runs intracutaneously on one side of the wound

25. Department of Surgical Research and Techniques
Basic Surgical Practicals
Horizontal mattress suture line
1 cm from the wound edge
1 cm parallel to the wound edge, a double suture
deep in the subcutaneous layer
skin
in case of higher wound tension

26. Department of Surgical Research and Techniques
Basic Surgical Practicals 1 2 3 4

27. Department of Surgical Research and Techniques
Basic Surgical Practicals 1 2 3

28. Department of Surgical Research and Techniques
Basic Surgical Practicals
Running suture line
knot should be tied
only at the beginning
and the end
fast
the tension is distributed equally along the length of the suture – edema 
not so safe
peritoneum
vessels
skin
GI tract

29. Department of Surgical Research and Techniques
Basic Surgical Practicals 2. 1. 3. 4.

30. Department of Surgical Research and Techniques
Basic Surgical Practicals 1. 2. 4. 3.

31. Department of Surgical Research and Techniques
Basic Surgical Practicals
Suture removal 3. 2. 1.

32. Department of Surgical Research and Techniques
Basic Surgical Practicals
Running-lock closure
knot should be tied
only at the beginning
and the end
last knot – 3 tails
reduces the skin tension
results in more tissue eversion
skin

33. Department of Surgical Research and Techniques
Basic Surgical Practicals

34. Department of Surgical Research and Techniques
Basic Surgical Practicals
Running intracuticular closure
stitches run in the subcuticular plane
fast
cosmetically/aesthetically fine scar
knot should be tied
only at the beginning
and the end
skin
it is used in the skin with minimal wound tension

35. Department of Surgical Research and Techniques
Basic Surgical Practicals 1. 2. 3. 4.

36. Department of Surgical Research and Techniques
Basic Surgical Practicals

37. Department of Surgical Research and Techniques
Basic Surgical Practicals
Suture removal