 The first suturing which I am going to demonstrate will be, the knot tying technique I will show you where I put the sutures. Then we will come to that. We will do four suturing techniques. There are many of them written here or essential ones. The simple interrupt it. That is the first one you will learn. So let us do the whole thing now. We are going to hold the needle holder, the needle with the needle holder. We will use the thumb forces. Let us say I am going to do a suturing here. The first one, the simple, interrupted one. It is really not very difficult at all. So like I told you, you can hold it either this way or this way. I prefer to hold it this way because I get more control. You should be able to hear the clicks. Then you know how much pressure you will apply. Now it is stable. Note that no dacces. Note everything. Watch. So suppose I am doing the suturing with the tooth force. Hold one end of the place where you want to put the suture. Here for your guidance, they have only put dots here. In an actual situation you will not have these dots. So we have to determine approximately half a centimeter of the side to half a centimeter of that side. So take a good grip of the skin. It is a good grip so that you can lift it up. Take the first bite through full thickness. With a slight curving motion so that, as you can see in the lower picture, less of the epidermis and more of the dermis is taken. There is a meaning behind that. Because we want the edges to be slightly diverted. Inversion is not a good thing. Iversion is required that only gives a good healing. Epidermis to dermis, epidermis and dermis to dermis. And it produces a good helix. So that's why we have curved needles. Of course we do use straight needles for various situations but here curved is the... So a slight more of the epidermis, a little less of the dermis. Full thickness. If you find difficulty you can take it out and you can take the next one. Or you can do it both in one shot. It doesn't matter. It depends on how big the needle is and how deep the suture on the skin is. I've just removed it. So one bite. Next bite. Again take a good grip on the opposite side. Give a slight push and you can see the tip of the needle pushing. So I know approximately this is the place I want to come out. Once you release it, catch hold of the tip and pull it out with the curving motion. Keep pulling till you reach an approximate reasonable size. Don't keep this too long because remember you'll be cutting it off. This will be a waste. We have to conserve material. At least if you don't, your assistant is going to jump at you. So keep it a sufficient length so that we can afford to... Now, the previous slide where the knot tying technique is shown. Watch this. Another thing which I forgot to tell you about the suture material was when I was talking about is the knot holding characteristics of suture materials. These monofilament materials, synthetic non-absorbable monofilament material, they tend to slip. You can try it. You can take a piece of nylon and you try to make a loop. You make two throws of a knot and it will slip off. If you take a cotton, two throws, or your shoelace for example, you don't put ten knots. It holds. Nylon synthetic material, they tend to slip. So we have to use multiple throws, otherwise they will slip. Now how to tie the knot? Long end. Two loops clockwise. Tip. Hold the tip. Give it sufficient pull to make it a little tight. But it is not sufficiently tight yet because it will slip off. See, it is already slipping out. Now with my hand like this, anticlockwise two loops. Again hold the tip. And same direction. My hand will come back to the left. Tighten a little bit. Four throws. Two-two. I usually like to put six or eight. Because anything less than that tends to slip. Again two loops. Catch hold of the tip. Again cross. Again two loops. Anticlockwise, catch hold of the tip. And once you have finally made the knot eight throws, give a little flip like that. So that the knot goes away from the suture line. Either this side or this side. Never keep the knot on the suture line because it will give a very painful and bad scar. Once this is over, don't remove it. Keep the tension. Take the scissor. Apex below the knot. Cut it approximately half a centimeter away. Why do we keep this much length? Two reasons. Reason number one. Seven days later you have to remove it. If you keep it too small, you will not get a good grip to remove it. I'm going to show you how to cut it. The second reason is, as I told you, they tend to slip. Even after the 48 throws, if I keep that end very small, it might slip off. So I'm going to do one another one fast. And then I'm going to cut towards the knot and then you will start doing your own. So this is the technique. I'm going to do the next one one more. Just so that you can see it. Good grip. Full thickness. Little more of the epidermis. Opposite side. Full thickness. Coming out. Double clockwise. Hold the tip. Anti-clockwise. Hold the tip. Clockwise. Hold the tip. Anti-clockwise. Hold the tip. Flip. The full technique. Seven days later, the patient comes to you. You are going to remove this. That slide is also there. How many days later to remove the sutures? Most times it's seven days. Sometimes it's five days. Sometimes it's nine days. Sometimes it's ten days. We will take the average figure. Seven days. Catch hold of a grip with the tooth force. Catch hold of the knot. Get a good grip. Not on the suture line, but away from the suture line, put the pointed portion under the loop. And when you're pulling out the knot, don't pull this way. Because I have experienced it. Sometimes the suture line is still not fully healed. When you pull this way, it pops open. So pull like this. Next one. Get a good grip. Put the pointed end under the loop. Away from the suture line. Cut with the tip. Pull. Pull procedure is done. Please go back to your specter stations and start over the first suturing.