General Surgery

Suturing – Instrument holding

Key principles

Maintain a light grip on the needle holders

  • Thumb and ring finger, first knuckle only
  • Not a death grip!
  • Advanced: no thumb in the ring – use your thumb pad to open and close the ratchet


Thumb forceps held like tweezers or a pencil

  • No overhand grips
  • Advanced: don’t set them down


Rotate arm and wrist to move the needle

  • Avoid pushing the needle through with a straight force
  • If your needle is straightening on you, you aren’t rotating your arm

Needle holders are positioned over the knot for tying

  • Between the strands of suture
  • Not underneath either strand

Don’t pull up on the knot

  • Keep needle holders close to the skin
  • Don’t move the needle holders up and down
  • Use your opposite hand to wrap the suture around the needle holders

Control your suture

  • Keep your hands where you can see them
  • Wrap or fold the suture into your other hand to keep it under control

How to use your thumb forceps to stabilize the needle



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Large Animal Surgery - Supplemental Notes Copyright © by Erin Malone, DVM, PhD is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.