Suturing basic techniques and types what all I need to tell in a teaching course

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Suturing: Basic Techniques & Types — Teaching Course Guide

This covers everything you need to teach in a structured suturing course, organized from foundations to hands-on technique.

1. WOUND ASSESSMENT & PRE-SUTURING PREPARATION

Before picking up a needle, trainees must understand wound readiness:

Wound Evaluation

Mechanism: Sharp lacerations have discrete edges; blunt injuries cause tissue edema, devitalization, and slower healing
Time since injury: Primary closure generally safe up to 24 hours for facial wounds; contaminated wounds may need delayed primary closure
Foreign body exclusion: Palpate and explore — soil, glass, wood fragments increase infection risk
Deep structure involvement: Nerves, tendons, vessels, facial muscles

Wound Preparation Steps

Cleanse surrounding skin with chlorhexidine or povidone-iodine — avoid introducing antiseptic into the wound (toxic to tissue)
Anesthetize prior to exploration and irrigation
Explore to exclude foreign bodies, deep injuries
Irrigate copiously using a large syringe with splash guard — retract wound edges to reach deep recesses
Debride grossly contaminated or devitalized tissue (minimize debridement on the face — excellent blood supply enables recovery)
Sterile drape, assemble instruments, ensure adequate lighting

— Roberts and Hedges' Clinical Procedures in Emergency Medicine

2. SUTURE MATERIALS

Absorbable vs. Non-Absorbable

Property	Absorbable	Non-Absorbable
Definition	Loses >50% tensile strength within 2 months	Retains tensile strength
Use	Deep dermal, subcutaneous layers	Epidermal/skin surface closure
Removal needed	No	Yes (7–14 days)
Rationale	Wound has only 5–10% original skin strength at 2 weeks; suture supports until scar matures	Provides external approximation only

Monofilament vs. Multifilament

Property	Monofilament	Multifilament (Braided/Twisted)
Friction	Low — pulls through tissue easily	Higher
Memory	High — tendency to revert to original shape	Low
Knot security	Lower — needs more throws	Higher — fewer throws needed
Infection risk	Low capillarity, low tissue reactivity	Higher capillarity — traps fluid/bacteria
Examples	Nylon, polypropylene, PDS	Vicryl, polyester

Suture Size (USP Scale)

Dermatologic/surgical range: 3-0 to 6-0
Diameter is inversely related to the first digit — 3-0 is thicker/stronger than 6-0
Tensile strength is directly proportional to diameter
Number of knot throws generally corresponds to suture size (4-0 → 4 throws, 5-0 → 5 throws)

— Fitzpatrick's Dermatology, Vol. 1 & 2

3. INSTRUMENTS

Teach proper use of:

Needle driver — for suture placement and tying
Tissue forceps with teeth / skin hook — to elevate wound edge without crushing tissue
Iris scissors — for suture cutting
Adson forceps — fine tissue handling

Needle types to cover:

Cutting needle — triangular cross-section, for skin (tough tissue)
Reverse cutting — cutting edge on outer convex side, less tissue tear
Tapered needle — for delicate tissue (bowel, vessels)

4. INSTRUMENT TIE — THE SQUARE KNOT

This is the foundation before teaching any stitch type:

Steps (Instrument Tie):

Place needle driver parallel to the wound; wrap the long suture end twice over the driver → this is the surgeon's knot (double first throw prevents loosening)
Grasp the short suture end on the opposite side of the laceration; pull to tighten — approximate edges only, do not overtighten (causes tissue strangulation)
Rotate driver 90°; place long suture over driver once (single wrap for throws 2–4)
Continue for a total of 4 throws (for 4-0 suture)
Move the knot to one side of the wound — never resting directly over the edges
Leave 1–2 cm tails — too short risks unraveling; too long is a nuisance at removal

— Roberts and Hedges' Clinical Procedures in Emergency Medicine

5. SUTURE TECHNIQUES — TYPES

5A. Simple Interrupted Suture

The most basic and widely used technique.

Technique:

Enter skin at 90° to the wound surface
Needle enters and exits equidistant from wound edges
Take a larger bite at depth than superficially to achieve wound edge eversion
First suture placed at midpoint of wound → bisect each segment until complete closure

Advantages: Excellent approximation for irregular/complex lacerations; failure of one suture does not compromise entire closure Disadvantages: Time-consuming; risk of tissue strangulation if over-tightened Uses: Low-tension wounds; complex/irregular lacerations

5B. Continuous (Running) Percutaneous Suture

Best for long linear lacerations — fastest technique.

Technique:

Begin with a simple interrupted suture anchored at one end
Continue placing sutures in a running fashion without cutting between bites
Lock with a final knot at the opposite end

Advantages: Rapid; accommodates post-closure edema Disadvantages: Less meticulous than interrupted; wound may dehisce entirely if a single knot unravels (especially without deep sutures) Uses: Long linear wounds; percutaneous closure in conjunction with deep sutures

5C. Deep Dermal (Buried) Suture

Critical for high-tension wounds — reduces surface tension.

Technique:

Needle enters the deep dermis and exits at a superficial level
Knot is buried within the wound (inverted knot)
Provides structural support, allows early removal of percutaneous sutures → reduces hatch-mark scarring

Advantages: Reduces tension on skin surface; enables early percutaneous suture removal; may reduce scar width Disadvantages: May increase infection risk in contaminated wounds Uses: High-tension wounds; closure of dead space

5D. Continuous Subcuticular (Intradermal) Suture

Best cosmetic result — no percutaneous punctures on the skin surface.

Technique:

Anchor suture at one end; run the suture horizontally within the dermis parallel to the skin surface
Alternating bites on each side advance along the wound
Tie off or use a bead/bolster at the exit point

Advantages: Rapid; reduces/eliminates need for percutaneous sutures; minimal scarring; cosmetically excellent Disadvantages: Technically difficult; less accurate approximation; entire wound may dehisce if knot fails Uses: Cosmetically visible areas (face, neck, décolleté)

5E. Vertical Mattress Suture

Best for wound edge eversion — especially in areas prone to inversion.

Technique:

Far-far entry and exit (wide, deep bite)
Re-enter close to wound edge on the same side (near-near bite), closer to the surface

Advantages: Excellent wound edge eversion; eliminates dead space; good for areas with thick skin or tendency to invert (e.g., back, neck) Disadvantages: Time-consuming; more tissue trauma; higher risk of hatch-marking (remove early) Uses: High-tension wounds; back, posterior neck

5F. Horizontal Mattress Suture

Excellent for wounds with poor circulation.

Horizontal mattress suture diagram showing the needle path passing horizontally through layered tissue

Technique:

Two parallel bites placed horizontally across the wound
Forms a rectangular suture pattern — knot tied on one side

Advantages: No percutaneous punctures at wound edges (preserves circulation); good for wounds under tension; rapid placement Disadvantages: Can strangulate tissue if over-tightened Uses: Wounds with compromised edge vascularity; fascial closure; high-tension wounds; fragile tissue

— Tintinalli's Emergency Medicine; Fitzpatrick's Dermatology

6. QUICK REFERENCE — SUTURE TECHNIQUE SELECTION TABLE

Suture Type	Advantages	Disadvantages	Best Use
Simple interrupted	Excellent for irregular wounds	Time-consuming	Low-tension, complex lacerations
Continuous percutaneous	Rapid; accommodates edema	Dehiscence risk if knot fails	Long linear lacerations
Deep dermal (buried)	Reduces surface tension	Infection risk in contaminated wounds	High-tension wounds
Continuous subcuticular	Best cosmesis; no surface marks	Technically difficult	Cosmetically sensitive areas
Vertical mattress	Excellent eversion	Hatch-marking; time-consuming	Thick skin, inversion-prone sites
Horizontal mattress	Preserves edge perfusion	Strangulation risk	Poor-circulation wounds; fascia

7. WOUND EDGE EVERSION — KEY CONCEPT

Emphasize this heavily in teaching:

Ideal closure = meticulous wound edge approximation + eversion
As wound contracts during healing, an initially flat closure will invert → leading to a depressed, visible scar
Eversion ensures the final healed scar is flat or slightly raised → contracts to level surface
Achieved by: correct needle angle (90°), adequate depth of bite, vertical mattress technique when needed

— Fitzpatrick's Dermatology

8. REGIONAL CONSIDERATIONS

Face

Use non-absorbable monofilament (e.g., 5-0 or 6-0 nylon)
Place sutures 1–2 mm from edges, 2 mm apart
Consider tissue adhesive for minimal-tension facial wounds (no mucosa, no hair)
Tissue adhesive indications: minimal tension, epidermal only, no hair-bearing area
Remove early (5–7 days) to minimize hatch marks

Scalp

Thick skin with rich blood supply — significant hemorrhage risk from arterial lacerations
May use staples for rapid closure
3-0 or 4-0 non-absorbable

Mucosa

Use absorbable suture (Vicryl)
Place 2–3 mm from edges, 2–3 mm apart
Superficial bites — do not incorporate underlying muscle/fascia

High-tension areas (back, joints)

Always use deep dermal sutures first
Vertical or horizontal mattress for surface
Consider delayed suture removal

9. SUTURE REMOVAL TIMING

Location	Removal Timing
Face	5–7 days
Scalp	7–10 days
Trunk	7–10 days
Extremities	10–14 days
Over joints	14 days
Hands/feet	10–14 days

Removal technique: Pull toward the wound line (not away from it) to avoid tearing apart a healing wound.

10. COMPLICATIONS TO TEACH

Complication	Cause	Prevention
Wound dehiscence	Knot failure, excess tension, early removal	Proper knot technique; deep sutures for tension; correct timing
Hatch-mark scarring	Sutures left too long; over-tightening	Early removal on face; vertical mattress on back
Infection	Inadequate irrigation; braided suture in contaminated wounds	Thorough irrigation; monofilament in contaminated sites
Tissue strangulation	Sutures tied too tightly	Approximate, don't strangulate
Dead space	Incomplete closure of layers	Use buried/deep dermal sutures
Wound inversion	Inadequate eversion technique	Correct needle angle; vertical mattress as needed

11. SUGGESTED COURSE STRUCTURE

Session	Content
Session 1	Wound healing phases; anatomy of skin layers; suture materials
Session 2	Instruments; needle types; knot tying (square knot, surgeon's knot)
Session 3	Simple interrupted + continuous running — wet lab on tissue pads
Session 4	Deep dermal + subcuticular — wet lab
Session 5	Mattress sutures (vertical + horizontal) — wet lab
Session 6	Regional considerations (face, scalp, joints); wound complications
Assessment	OSCE on fresh tissue/simulation model

Sources:

Fitzpatrick's Dermatology, 9th Ed., Vol. 1 & 2 — Suture Materials & Techniques (Ch. 202)
Tintinalli's Emergency Medicine — Wound Closure, Ch. 41–42
Roberts and Hedges' Clinical Procedures in Emergency Medicine — General Suturing Technique, Ch. 35

Suturing basic techniques and types what all I need to tell in a teaching course

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Excellent — I now have comprehensive textbook content and high-quality diagrams from Fitzpatrick's Dermatology and Roberts & Hedges. Here is the complete teaching course guide:

Suturing: Basic Techniques & Types — Complete Teaching Course

Based on: Fitzpatrick's Dermatology (9e), Roberts and Hedges' Clinical Procedures in Emergency Medicine, Tintinalli's Emergency Medicine

MODULE 1 — GOALS OF WOUND CLOSURE

Start by anchoring the "why" before the "how":

"Repair of a surgical defect should maximize cosmetic and functional outcomes. An ideal wound closure consists of meticulous wound edge approximation and eversion." — Fitzpatrick's Dermatology

Key goals to state upfront:

Approximate wound edges precisely in all three dimensions
Evert wound edges slightly (prevents depressed scars after wound contraction)
Minimize tension and eliminate dead space
Minimize suture track marks (especially in cosmetically sensitive areas)
Restore anatomic contours

MODULE 2 — WOUND PREPARATION (Before Any Suture Is Placed)

Teach this as a non-negotiable sequence:

Step	Action	Key Point
1	Cleanse surrounding skin	Chlorhexidine or povidone-iodine — do not introduce antiseptic into the wound (toxic to tissue)
2	Anesthetize	Before exploration or irrigation
3	Explore	Exclude foreign bodies, deep structure injuries (tendons, nerves, vessels)
4	Irrigate copiously	Large syringe + splash guard; retract wound edges to reach deep recesses
5	Debride	Remove grossly contaminated or devitalized tissue
6	Setup	Sterile drape, instruments laid out, adequate lighting

MODULE 3 — INSTRUMENTS

Teach correct handling of each before placing any suture:

Needle driver — used for suture placement and knot tying; held like a pencil, not in a fist
Tissue forceps with teeth / skin hook — elevate wound edges without crushing; use the tip of one tine of the forceps to minimize damage
Iris scissors — for cutting suture tails
Adson forceps — fine tissue handling

Needle Types

Type	Cross-section	Use
Conventional cutting	Triangular, cutting edge on inner curve	Skin
Reverse cutting	Triangular, cutting edge on outer curve	Skin, fascia — less tissue tear, preferred
Tapered/round-bodied	Round	Delicate tissue — bowel, vessels, subcutaneous

Teaching point: The motion of the needle holder must mimic the curve of the needle — pronate the wrist so the needle enters the skin perpendicularly; this helps evert the wound edge.

MODULE 4 — SUTURE MATERIALS

4A. Absorbable vs. Non-Absorbable

Property	Absorbable	Non-Absorbable
Definition	Loses >50% tensile strength within 2 months	Retains tensile strength indefinitely
Primary use	Deep layers: dermis, subcutaneous	Skin surface (epidermal) closure
Removal	Not required	Required at 5–14 days
Rationale	At 2 weeks, scar has only 5–10% of original skin strength — suture supports until scar matures	Provides surface approximation, not structural support

4B. Monofilament vs. Multifilament

Property	Monofilament	Multifilament (Braided)
Friction	Low — passes easily through tissue	Higher friction
Memory	High — tendency to revert to original shape	Low memory
Knot security	Lower — needs more throws to prevent unraveling	Higher — fewer throws needed
Infection risk	Low capillarity → low tissue reactivity, low infection risk	Porous structure traps fluid and bacteria → higher infection risk
Examples	Nylon, polypropylene, PDS, Monocryl	Vicryl, Dexon, silk

4C. Suture Size (USP Scale)

Diameter is inversely proportional to the first digit: 3-0 is thicker/stronger than 6-0
Tensile strength is directly proportional to diameter
For skin: typically 3-0 to 6-0
Number of knot throws = suture size number (4-0 → 4 throws, 5-0 → 5 throws)

4D. Commonly Used Sutures (Quick Reference)

Suture	Type	Absorbable	Common Use
Plain gut	Monofilament	Yes	Mucosa
Chromic gut	Monofilament	Yes	Mucosa, oral cavity
Vicryl (polyglactin)	Braided	Yes	Deep dermal, subcutaneous
PDS (polydioxanone)	Monofilament	Yes	Deep layers needing prolonged support
Monocryl (poliglecaprone)	Monofilament	Yes	Subcuticular
Nylon (Ethilon, Dermalon)	Monofilament	No	Skin surface
Prolene (polypropylene)	Monofilament	No	Skin, subcuticular
Silk	Braided	No	Oral mucosa (tied loosely)

MODULE 5 — KNOT TYING (Foundation Before Any Stitch)

Teach the instrument tie first — this is the square knot.

Instrument Tie — Step by Step:

Place the needle driver parallel to the wound; wrap the long suture end twice around the driver → this is the surgeon's knot (double first throw prevents loosening while you grab the other end)
Grasp the short end on the opposite side of the laceration; pull ends toward opposite sides to approximate — not strangulate — edges
Rotate driver 90°; wrap long end once over driver (single wrap for all subsequent throws)
Repeat for total of 4 throws (for 4-0 suture)
Move the completed knot to one side of the wound — never resting directly over the wound edge
Cut tails to 1–2 cm — too short risks unraveling; too long is a nuisance at removal

Teaching point: Sutures tied too tightly compromise blood supply to wound edges → increased infection risk and suture marks can form within 24 hours.

MODULE 6 — SUTURE TECHNIQUE TYPES

6A. Simple Interrupted Suture

The most basic and most commonly used technique — teach this first.

Technique:

Enter needle at 90° to skin surface on one side
The bite should be wider at depth than at surface (bottle-shaped / flask-shaped path) — this is what achieves eversion
Enter and exit at equal distances from wound edge on both sides
Tie with a square knot; move knot to one side

Bisecting rule for wound closure: Place first suture at the midpoint of the wound → bisect each segment sequentially until complete — prevents uneven approximation

Advantages: Best for irregular/complex lacerations; if one suture fails, others hold; allows staged removal Disadvantages: Time-consuming; risk of strangulation if over-tightened Best for: Low-tension wounds, complex lacerations, areas of concern for impaired healing

6B. Deep Dermal / Buried Interrupted Suture ("Heart-Shaped" Buried Suture)

Heart-shaped subcutaneous buried suture — needle enters deep, sweeps upward on both sides, with the knot tied at depth and buried beneath the surface

Figure 202-1: "Heart-shaped" subcutaneous buried suture — Fitzpatrick's Dermatology

Technique:

Needle enters deep in subcutis on one side, sweeps upward to exit in superficial dermis
Re-enters superficial dermis on the opposite side, sweeps down
Knot is buried (tied at depth, faces downward) — cannot be felt on surface

Why it works: The heart-shaped path means the deepest point of the bite is at the bottom → as suture tightens, wound edges are drawn together AND everted

Advantages: Reduces tension at the skin surface; supports wound during critical early healing; allows early epidermal suture removal; reduces scar width; eliminates dead space Disadvantages: May increase infection risk in contaminated wounds Best for: High-tension wounds; layered closure; cosmetically sensitive areas

6C. Continuous (Running) Percutaneous Suture

Fastest technique — best for long linear lacerations.

Technique:

Anchor with an initial interrupted suture at one end (not cut)
Continue placing sutures in a running fashion without cutting between bites
Lock with a final knot at the other end

Advantages: Rapid closure; accommodates postoperative edema (tension distributed along entire length) Disadvantages: Less precise than interrupted; entire wound may dehisce if the single end-knot unravels — especially if no buried sutures were placed Best for: Long linear lacerations; combined with deep sutures

6D. Running Locking Suture

Variant of the running suture — needle passes through the previous loop before placing the next
Stronger than simple running; useful for hemostasis in well-vascularized wounds (e.g., scalp)
Risk: wound-edge necrosis if placed too tightly or if significant postoperative swelling occurs
Avoid at sites with tendency for inversion

6E. Horizontal Mattress Suture

Horizontal mattress suture showing needle path passing horizontally through layered tissue with bolsters to protect tissue edges

Figure 202-2: Horizontal mattress suture — Fitzpatrick's Dermatology

Technique:

Place a bite across the wound (far side to near side)
Advance parallel to the wound; place a second bite back across
Tie — forms a rectangular suture pattern

Advantages: Excellent for wounds with poor edge vascularity (no percutaneous punctures at wound edge); provides hemostasis; good wound-edge eversion; useful as a temporary bridging suture to reduce tension while placing deep sutures Disadvantages: Can strangulate tissue if over-tightened; risk of wound-edge necrosis → use bolsters to protect tissue Best for: Wounds with compromised perfusion; fascial closure; high-tension closures; bridging sutures

6F. Vertical Mattress Suture

Best technique for wound-edge eversion.

Vertical mattress suture — far-far then near-near bite sequence shown in four steps, resulting in everted edges

Figure 202-3: Vertical mattress suture — Fitzpatrick's Dermatology

Technique (mnemonic: "Far-Far, Near-Near"):

Far-Far: Enter far from wound edge on one side → cross wound deep → exit far from wound edge on other side
Near-Near: Re-enter near the wound edge on that same side → cross superficially → exit near the wound edge back on original side
Tie

Why it works: Acts as both a buried suture and an epidermal suture combined — minimizes dead space and produces powerful eversion

Advantages: Excellent eversion; eliminates dead space; reduces tension; particularly useful on thick skin or inversion-prone areas Disadvantages: Time-consuming; paired suture track scars if left too long → remove early; risk of necrosis under excessive tension Best for: Back, posterior neck, extensor surfaces; thick skin; wounds prone to inversion

6G. Running Subcuticular (Intradermal) Suture

Best cosmesis — no percutaneous marks.

Technique:

Anchor at one end; run the suture horizontally within the superficial dermis, alternating sides
The needle never breaks the skin surface
Exit and secure with a knot or subcutaneous bead/bolster at the other end

Materials: Absorbable monofilament (Monocryl, PDS) — can be left to absorb. Non-absorbable polypropylene — clear suture if leaving long-term; requires eventual removal.

Advantages: No surface suture tracks → no hatch-mark scars; ideal when sutures need to stay longer than 7 days Disadvantages: Technically difficult; less accurate if wound edges are uneven; entire wound dehisces if knot fails Best for: Cosmetically visible areas; wounds that are already well-approximated by buried sutures; pediatric patients

MODULE 7 — WOUND EDGE EVERSION: THE MASTER CONCEPT

Emphasize this as the single most important skill concept:

"As wound contraction normally occurs during healing, wound edge eversion at the time of closure promotes the development of a flat, smooth scar. If the wound edge is not sufficiently everted, wound contraction may increase the risk of a depressed or spread scar." — Fitzpatrick's Dermatology

How to teach eversion:

Correct needle angle — perpendicular entry, bottle-shaped path (wider at depth)
Lift and turn wound edge outward with skin hook or toothed forceps before inserting needle
Alternatively, press closed forceps adjacent to wound edge to push it upward
Slightly everted edges will flatten during healing → flat, level scar
Inverted edges → catches light as a shadow → visible, depressed scar

MODULE 8 — SUTURE TECHNIQUE SELECTION TABLE

Technique	Advantages	Disadvantages	Best Use
Simple interrupted	Precise; individual suture failure safe	Slow	Low-tension, complex, irregular wounds
Deep dermal (buried)	Reduces tension; allows early surface removal	Infection risk in contaminated wounds	High-tension; layered closure
Continuous running	Fast; distributes tension	Dehiscence if knot fails	Long linear wounds with buried sutures
Running locking	Strong; hemostatic	Necrosis risk if tight	Scalp; vascular wounds
Horizontal mattress	Preserves edge vascularity; hemostasis	Strangulation risk	Poor perfusion; fascia; bridging
Vertical mattress	Best eversion; closes dead space	Slow; hatch marks	Thick skin; inversion-prone sites
Running subcuticular	No track marks; best cosmesis	Technically hard; all-or-nothing failure	Cosmetically sensitive; long-stay sutures

MODULE 9 — REGIONAL TIPS

Site	Suture Choice	Size	Technique Notes
Face	Non-absorbable monofilament (nylon)	5-0 or 6-0	1–2 mm from edge, 2 mm apart; consider tissue adhesive for minimal-tension, non-hairy wounds
Scalp	Non-absorbable or staples	3-0 or 4-0	Rich blood supply; running locking helps hemostasis
Oral mucosa	Absorbable (chromic gut, Vicryl)	3-0 or 4-0	2–3 mm from edge; superficial — mucosa only, not underlying muscle
Trunk/back	Deep + surface	3-0 deep, 4-0 surface	Always use buried sutures first; vertical mattress for surface
Over joints	Strong, deep support	3-0 or 4-0	High tension — buried sutures essential; delayed removal

MODULE 10 — SUTURE REMOVAL TIMING

"Crosshatch marks can be minimized by removing sutures within a week of placement, before the formation of epithelial suture tracks." — Fitzpatrick's Dermatology

Location	Removal Timing
Face and ears	5–7 days
Neck	7 days
Scalp	7–10 days
Trunk and extremities	10–14 days
Over joints / high tension	14 days (or 3–4 extra days if dehiscence risk)

Removal technique: Always pull toward the wound line — never away from it (pulling away tears the healing wound apart).

If wound well-approximated at 7–10 days with good buried sutures: epidermal sutures may be removed early and steri-strips applied for continued support.

MODULE 11 — COMPLICATIONS TO TEACH

Complication	Cause	Prevention
Wound dehiscence	Knot failure; excess tension; premature removal	Proper knot technique; buried sutures for tension
Hatch-mark (crosshatch) scarring	Sutures left too long; over-tightened	Remove on time; don't strangulate; use subcuticular for long-stay
Tissue strangulation/necrosis	Sutures tied too tight	Approximate, do not strangulate; use bolsters on mattress sutures
Wound infection	Inadequate irrigation; braided suture in contaminated wounds	Copious irrigation; monofilament in contaminated wounds
Dead space → seroma/hematoma	Failure to close deep layers	Layered closure with buried sutures
Wound inversion → depressed scar	Flat or inverted closure technique	Correct needle angle; eversion techniques

MODULE 12 — SUGGESTED COURSE STRUCTURE

Session	Content	Format
1	Wound healing phases; skin layer anatomy; goals of closure	Lecture + diagrams
2	Suture materials (absorbable/non-absorbable, mono/multifilament, sizes)	Lecture + material handling lab
3	Instruments; needle types; instrument tie / square knot	Hands-on — foam pads
4	Simple interrupted + deep buried suture	Wet lab — pig trotters/chicken thigh
5	Continuous running + running subcuticular	Wet lab
6	Vertical and horizontal mattress sutures	Wet lab
7	Regional considerations; eversion principles; complications	Case-based discussion
8	OSCE assessment	Fresh tissue / simulation model

Sources:

Fitzpatrick's Dermatology, 9th Edition — Suture Materials (Ch. 202), Suturing Technique (Ch. 202), Suture Removal (Ch. 203)
Roberts and Hedges' Clinical Procedures in Emergency Medicine — Suture Material (Ch. 35), General Suturing Technique, Instrument Tie, Eversion Techniques
Tintinalli's Emergency Medicine: A Comprehensive Study Guide — Suture Techniques (Ch. 41)

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