 Our job is to achieve correct union of the skin edges and achieve healing by primary attention. So this is a needle holder. How do we distinguish a needle holder from an artery holder? Straight artery holder. A needle holder will have a smaller jaw and a longer stem. An artery holder will do the opposite. It will have a longer jaw and a smaller stem. Technique of holding these instruments. The ring finger should go through the lower ring. The thumb should go through the upper ring. The middle finger will control it at a junction, a ratchet. And the index finger will give it a little release. This is the jaw. This is the thumb. This is the ratchet. Most instruments have three clicks of the ratchet. One, two, three. Depending on how tight a grip we want. Okay. Coming to the needles which are used for suturing. Broadly there are two types. A round-bodied needle and a cutlery depending on the cross-sectional appearance. For tough structures like skin, rectus sheath, linear alma, we use a cutting needle. While for delicate structures like peritoneum, mesentery, and intestine, we use a round-bodied needle. Since we are dealing with the skin here, we are going to use a cutting needle. So, let's say the patient has come to his fin injury. First, we use the needle holder and hold it at a junction between the needle holder and the lateral bumper. Two clicks is usually sufficient. If the needle still rotates, we can make a third click. This is a thumb force. Because it is held between thumb and index finger. Again, thumb force is for a tooth end. Those which have got a tooth end, you will see that one end is for a single tooth and the other end is for a double tooth. This is to grasp the structure firmly between the tooth. This is called a toothed force. Tooth force is used for structures like skin. Again, tough structures. Other type of thumb force is the plain thumb force, which does not have the tooth. We use those delicate structures like peritoneum, intestine, mesentery, etc. Since we are dealing with the skin here, we are using a toothed thumb force and we are using a cutting needle. This is nylon or polypropylene, which is a synthetic material. Let's demonstrate first a simple suture. A simple suture. We have already held the needle in our needle holder. We go approximately half a centimeter away from the skin edge, pick up the whole skin without tooth force. Take a full thickness bite. Without taking the needle out, pick up the other end and take a full thickness bite. Push it in a curved direction and catch hold of the other end and pull it out with a curving motion. Take two loops and tighten it. This is a simple stitch. Our aim of suturing is to ensure neat opposition of the epidermis and the dermis so as to give a healing by primary intention. This is the simplest and fastest technique. If you are confident with it, this is pretty good. If you can achieve this, this is pretty good. Remember another thing. For nylon, we have to take at least six throws, but not otherwise it tends to slip. And each loop should be opposite to the previous one as I am doing now. So that it does not slip. There it goes. So this is a simple stitch. When it comes to cutting the thread, we should always cut approximately half a centimeter to three quarters of a centimeter away from the knot. Why? For two reasons. Number one, if you cut it too close to the knot, we might allow the knot to slip. And the second reason is, when we have removed the sutures, we will have something to grasp it. We will have something to grasp it. And then we can remove it by putting the pointed end of the scissors under the knot. Loop of the knot, thread and cutting and pulling it out. So for this reason, we must have sufficient length so that we can grasp it. For these two reasons, we should not cut it too close to the knot. Usually this. So that was a simple stitch. Now let's demonstrate the vertical matrix. Again, the first step is pretty much the same. Hold it the way I demonstrated. Full thickness bite. Full thickness bite without taking it out. Push. And put it out of the curving motion. Next, hold it close to the tip. Hold it close to the tip. Now we have to go very minutely at the dermal epidermal junction. This is the dermal epidermal junction. And from this side and the same thing from the other side also. We pick up this end. Again, dermal epidermal junction. There we go. Push. Take it out. Now what we have achieved is union of the epidermis to the epidermis and the dermis to the dermis. Again, now we. And we put in the same number of throws. Very good. And so that was a vertical matrix. And now I'm going to demonstrate the third variety. Horizontal matrix. When do we do the horizontal matrix? When we want speed. Quick. And when there's too much of profuse bleeding coming from the edges which cannot be controlled. And we can sacrifice cosmetic beauty at the expense. And the expense of cosmetic beauty will achieve speed and control of bleeding. The first step is pretty much the same. Take a full thickness bite. Push. Take it out. Keep one end short as usual. Now take again the reverse way and go a little far away. Go in the opposite direction. This way and... Now when we turn the other end, Now when we tighten this, This may not be cosmetically as beautiful. But what we have achieved is, in one knot we have covered a big area and we have also stopped the bleeding in that place. And again tighten. Put as many throws as are required. Six throws for now. At least six throws for now. So this is horizontal madness. And then fold it many end cuts. So vertical madness, horizontal madness. So now all of you can practice.