Suturing Course

Lesson 1 • Anesthesia Basics for Wound Closure

Introduces local infiltration and field block techniques using common anaesthetic agents. Safe anaesthesia delivery is prerequisite to hands-on suturing practice.

Lesson 2 • Wound Assessment and Classification

Teaches systematic evaluation of wound depth, contamination, and tissue viability. Accurate classification drives closure method selection covered in Chapter 2.

Lesson 3 • Skin Anatomy and Wound Layers

Covers epidermis, dermis, subcutaneous tissue, and fascia as they relate to closure decisions. Provides the anatomical basis for selecting suture depth and technique.

Lesson 4 • Principles of Wound Healing

Explains haemostasis, inflammation, proliferation, and remodelling phases. Links healing biology to timing and technique choices throughout the course.

Lesson 1 • Suturing Instruments and Their Use

Introduces needle drivers, tissue forceps, scissors, and retractors with correct grip and function. Instrument mastery is foundational to all technique chapters that follow.

Lesson 2 • Non-Absorbable Suture Materials

Covers silk, nylon, polypropylene, and polyester sutures with their handling and removal timelines. Connects material choice to wound location and cosmetic outcome.

Lesson 3 • Needle Anatomy and Selection

Details needle body shape, point geometry, and swage attachment. Proper needle choice minimises tissue trauma and improves passage control.

Lesson 4 • Suture Sizing and Packaging

Explains the USP sizing scale, packaging labels, and sterility indicators. Correct size selection prevents tissue trauma and closure failure.

Lesson 1 • Instrument Tie and Square Knot

Demonstrates the two-handed and instrument-tie methods for forming a secure square knot. Knot integrity is the single most critical factor in suture holding strength.

Lesson 2 • Simple Interrupted Stitch Execution

Guides full stitch placement from entry to knot completion with correct spacing and eversion. Eversion prevents depressed scars and is reinforced throughout the chapter.

Lesson 3 • Vertical Mattress Stitch

Introduces the vertical mattress for high-tension wounds requiring strong eversion. Builds on simple interrupted mechanics with an added deep bite component.

Lesson 4 • Horizontal Mattress Stitch

Covers horizontal mattress placement for distributing tension across wound edges. Appropriate use cases and risks of ischaemia are emphasised for safe application.

Lesson 1 • Drain Placement and Wound Packing

Introduces passive and active drain selection and placement within closed wounds. Drain management complements layered closure when fluid accumulation is anticipated.

Lesson 2 • Dermal and Subdermal Closure

Addresses the dermal layer as the primary load-bearing closure plane for skin wounds. Proper dermal closure reduces surface suture tension and improves cosmetic outcome.

Lesson 3 • Subcutaneous Layer Closure

Covers buried interrupted and buried running techniques for obliterating subcutaneous dead space. Correct knot burial prevents suture extrusion and surface irregularity.

Lesson 4 • Fascial and Muscle Layer Closure

Teaches interrupted and running techniques for closing fascia and muscle with appropriate absorbable sutures. Fascial integrity is critical for preventing hernia and dehiscence.

Lesson 1 • Subcuticular Running Stitch

Demonstrates intradermal placement for cosmetically sensitive wounds with minimal scarring. Correct plane maintenance and exit strategy are the key technical challenges.

Lesson 2 • Terminating and Securing Running Sutures

Covers all methods for ending a running line, including Aberdeen knot and loop-to-loop techniques. Secure termination prevents catastrophic suture line failure.

Lesson 3 • Simple Running Stitch

Teaches the continuous simple running stitch with anchoring start and locking finish. Speed and tension consistency distinguish this technique from interrupted methods.

Lesson 4 • Locking Running Stitch

Adds the self-locking loop to each pass for haemostatic and high-tension applications. Students identify when locking is beneficial versus when it risks ischaemia.

Lesson 1 • Hand and Finger Wound Closure

Addresses tendon sheath proximity, digital nerve awareness, and fine closure on the hand. Functional outcome takes priority over cosmesis in hand wound management.

Lesson 2 • Scalp Laceration Repair

Covers galea closure, haemostasis, and staple versus suture decisions for scalp wounds. Scalp vascularity and hair follicle preservation require technique modifications.

Lesson 3 • Oral and Mucosal Wound Closure

Teaches absorbable suture selection and knot security for intraoral and mucosal lacerations. Wet environment and constant movement demand specific technique adaptations.

Lesson 4 • Paediatric Wound Closure Adaptations

Modifies technique, suture size, and patient management for wound closure in children. Behavioural considerations and tissue fragility require distinct procedural adjustments.

Lesson 1 • Scar Management and Revision Planning

Introduces hypertrophic scar, keloid, and widened scar management options after primary closure. Students counsel patients and plan revision timing based on scar maturity.

Lesson 2 • Suture Reactions and Extrusion

Addresses foreign body reactions, suture spitting, and granuloma formation from retained material. Students remove extruding sutures and manage reactive tissue appropriately.

Lesson 3 • Haematoma and Seroma Management

Explains formation mechanisms and drainage techniques for post-closure fluid collections. Prevention through layered closure and drain use is reinforced from Chapter 5.

Lesson 4 • Wound Dehiscence Assessment and Repair

Covers causes, grading, and management of partial and complete wound dehiscence. Students decide between re-closure, secondary intention, and wound VAC therapy.

Lesson 1 • Wound Closure Adjuncts

Covers tissue adhesives, skin staples, and adhesive strips as primary or adjunct closure tools. Students select adjuncts based on wound characteristics and patient factors.

Lesson 2 • Documentation and Patient Handoff

Establishes standards for procedural documentation, wound description, and follow-up instructions. Accurate records and clear handoff prevent post-procedure complications.

Lesson 3 • Tension-Relieving and Flap Techniques

Introduces undermining, advancement flaps, and Z-plasty for wounds under excessive tension. These techniques extend closure capability beyond primary edge-to-edge apposition.

Lesson 4 • Simulation-Based Skill Assessment

Uses structured simulation scenarios to evaluate technique accuracy, speed, and decision-making. Objective assessment criteria provide actionable feedback for each student.