Session 2: Close the Wound
This morning you read a patient's story in numbers. This afternoon you learn a skill that is 5,000 years old and still used in every operating room today: closing a wound.
Suturing is muscle memory. Nobody is good at it the first time, and everybody gets better fast. By the end of this session your hands will know how to place a stitch. Everything you do goes on your 📋 Patient Chart, Suturing page.
You are about to handle real surgical needles. A few habits keep the whole table safe:
- Point the needle away from yourself and your partner. When it is not in your hand, rest it in the foam pad.
- Pass instruments calmly, handle first. No reaching across someone's hands.
- Gloves on for the pad and banana work.
- We practice on bananas and pads, never on skin.
- Finished with a needle? It goes in the sharps container at the front.
A new patient just came into the ER. You are the team closing this wound.
Alex slipped carrying a tray and caught a forearm on the metal edge of a prep table. The cut is clean but deep, about 4 cm, deep enough to see the fatty layer underneath. Pressure has slowed the bleeding. It happened 40 minutes ago.
Talk it out in your group and record on your 📋 Patient Chart:
- Why does a wound have a time window before you can safely stitch it closed?
- What would you ask Alex before you close it? (Think about how, when, and their health history.)
- Besides stitches, what else does Alex need?
The simple interrupted suture, individual stitches that each stand on their own, is the global standard for closing a wound. Learn the tools, warm up your hands, then practice on a banana, then a wound pad.
- 1 needle driver, 1 tissue forceps, 1 pair suture scissors, 1 hemostat
- 1 silicone practice pad with a pre-cut wound
- Practice suture with a curved needle (4-0 nylon)
- 1 banana (your facilitator pre-slits these)
- Gloves, and a sharps container at the front
- 📋 Patient Chart, Suturing page
A surgeon never works alone. Instruments are passed handle first, one at a time, so no one is surprised by a sharp point. Everything is counted before the first cut and again before closing, so nothing is ever left inside a patient. And the whole team pauses for a "timeout" to agree on the patient and the plan before starting. You will use the same habits at your table today.
These grips are not about style. They are about control.
- Needle driver: hold it like a pen, or palm it with your thumb and ring finger in the rings. Clamp the needle about two-thirds back from the sharp tip.
- Tissue forceps: hold like a pencil to gently steady the edge of the skin. They are tweezers, not pliers.
- Suture scissors: for trimming the thread, nothing else.
- Hemostat: a locking clamp that holds things in place.
Surgery is a fine-motor skill. Wake up your hands first. Using only your needle driver and forceps (no fingers), move ten small objects from one cup to another. Time your group. Then run it again and beat your time. Notice how much steadier your second round is.
Banana peel behaves a lot like human skin, and it is forgiving. Place 3 simple interrupted sutures across the slit:
- Enter at 90 degrees, straight down into one edge.
- Follow the curve of the needle through both edges in one smooth motion.
- Pull until the edges just meet. Do not bunch them. Get the motion right before you move on.
Move to the silicone pad. It pushes back more like real tissue. Place 3 simple interrupted sutures on the pre-cut wound. Aim for even spacing (about 5 mm apart) and even tension: the edges should meet without the skin blanching white.
This is the hardest part, and the most satisfying once it clicks. Each stitch is locked with a square knot:
- First throw: wrap the long thread around the needle driver counterclockwise, grab the short tail, pull it through.
- Second throw: wrap clockwise, grab the tail, pull through. That reversal is what makes the knot hold. Repeat until your hands do it without thinking.
Score your best three stitches, 1 to 5, on your chart. Be honest. This is for your own improvement.
- Spacing: even, about 5 mm apart.
- Depth: consistent from stitch to stitch.
- Tension: edges meet, skin not pinched white.
- Knot: flat and secure, does not slip.
Surgeons in training place over 10,000 practice stitches before they ever close a real patient. Like a musical instrument, you cannot read your way to it. You have to do it.
Now make the plan for Alex and fill it in on your chart. Rule of thumb: about one stitch per 5 mm of wound length.
- Suture size: __________ (hint: 4-0 nylon for a forearm)
- Number of stitches for a 4 cm wound: __________
- Tetanus booster needed? Yes / No (dirty metal edge, when was Alex's last one?)
- Return to remove stitches in: __________ days (forearm heals in about 7 to 10)
- Aftercare: keep it clean and dry for 24 hours, then watch for redness, swelling, or discharge.
Here is how Alex's visit ended:
The wound was cleaned and closed with 8 stitches of 4-0 nylon. Alex's tetanus shot was out of date, so they got a booster. Home the same day with aftercare instructions, back in 7 to 10 days to have the stitches removed. Full recovery expected, with a small scar to tell the story.
Scan the code with your phone camera, or use the board below. Post a photo of your best suture line, plus one thing that got better from the banana to the pad.
Quick reflection, on your chart:
- How did your stitches change from your first to your last?
- Which was harder, placing the stitch or tying the knot? Why?
- Where else in the world do you think people use these exact skills?
A lot of people close wounds for a living, and it is not only surgeons. Scroll through the cards below together. Then, with your partner:
- Pick the two that surprise you or that you would want to learn more about.
- Talk it out: why those two? Which could you start the fastest? What is one step you could take while you are still in high school?
- Share back: tell the class one career and one thing about it that surprised you.
Today's tie: sets up the instruments and hands them to the surgeon, exactly the tools you just used.
Iowa first step: DMACC Surgical Technology program.
Pay, roughly: $50K to $60K.
Today's tie: every instrument you touched was cleaned and sterilized by someone in this job. No sterile tools, no surgery.
Iowa first step: DMACC Central Service and Sterile Processing course.
Pay, roughly: $40K to $48K.
Today's tie: runs the room, counts every sharp and sponge, and keeps the patient safe during surgery.
Iowa first step: DMACC Nursing degree, then specialize in the OR.
Pay, roughly: $70K to $85K.
Today's tie: the person actually placing the stitches. A surgical PA often does the closing while the surgeon starts the next case.
Iowa first step: a bachelor's, then Des Moines University (surgeon or 26-month PA) in West Des Moines.
Pay, roughly: PA $115K, Surgeon $300K and up.
Today's tie: vets suture every day, from farm animals to family pets. Same knots, different patients.
Iowa first step: Iowa State University in Ames runs one of the country's top veterinary schools.
Pay, roughly: $100K to $120K.
Today's tie: skin doctors remove growths and close the skin constantly. Suturing is a core part of the job.
Iowa first step: a bachelor's, then medical school such as the University of Iowa in Iowa City, then a dermatology residency.
Pay, roughly: $300K and up.