Needles and tissue are always manipulated with equipment: the forceps (tooth adsons) and needle driver, not with hands

Needle is properly held 2/3 from its tip.

Needle driver is appropriately held with thumb and fourth finger with extended index (students can practice palming the needle driver if desired).

Forceps properly held like a pencil with non-dominant hand.

The tissue forceps is used to evert the first wound edge.

The needle, held by the needle driver in the dominant hand, is inserted 0.5 cm away from the wound edge at 90 degrees (perpendicular to the skin).

The wrist supinates so that the needle passes through the dermis (outside-in).

The needle should exit near the dermis, without catching on the subcutaneous tissues.

The tissue forceps grasp the needle to stabilise it while the needle driver is unloaded, then they are used to pull the needle through.

The tissue forceps are used to re-load the needle onto the needle driver.

The tissue forceps are used to evert the opposing wound edge.

Needle is inserted at the dermis (or same level as the needle exit point on the opposite side) at 90 degrees to the wound tissues.

The wrist is supinated to move the needle through the skin (inside-out).

Needle exits the skin perpendicular to the skin edge, 0.5 cm from the wound edge.

The tissue forceps grasp the needle to stabilise it while the needle driver is unloaded, then they are used to pull the needle through.

Distance between the two bites on the skin is symmetric on each side of the wound.

The bites have the same depth in the wound.

The suture is pulled through so there is approximately 20-25 cm of length on the opposing side.

The thread is cut approximately 20-25 cm away from the wound using the scissors. The material is put away safely in preparation for the knot.

The material is put away safely in preparation for the knot.

Take one end of the thread in your right hand and the other in your left hand and cross the right over the left.

Pass the right thread under the left thread.

Tighten the knot by pulling the thread perpendicular to the wound.

Cross the left thread over the right thread.

Pass the left thread under the right thread.

Secure the knot by pulling apart on each thread.

 Alternate the directions of the thread at 180 degrees angles when tying the knot.

 Perform a total of 4 knots.

Cut both treads leaving approximatively 1cm using the scissors.

Supination and pronation of wrists.

Protection of the needle at the end of the intervention.

Threads are cut at an appropriate length; the scissors are at a 45 degrees angle and the surgeon can clearly see the knot.

Proper wound tension (no overlapping of tissues, no gaps).

Thread is well beneath the surface of the skin.

The edges of the wound must be close to each other, but not crushed together.