Part 3: Suturing
Suturing is the difference between scarring and healing, between infection and safety. The technique has barely changed in 5,000 years because it works. Today you learn the instruments, master the stitch, and close a wound on a scared teenage patient. Everything goes in your Casebook.
You work in pairs. Real surgical instruments and needles are on your tray, so slow hands and clear communication matter:
- Gloves on. Every needle goes straight into the sharps container, never loose on the table.
- Count your needles. Every needle that comes out must go back. This is real OR protocol.
- Keep the needle tip pointed at your work, never toward a person.
- Write your scores and your plan in your Casebook as you go.
- Why does Sofia have only a 6 hour window to close this wound?
- What could happen if the wound is not closed properly?
- Beyond the physical repair, what does Sofia need from her medical team right now?
Hold the needle driver like a pen, and load the needle about two thirds from the tip. Hold the tissue forceps like tweezers. The scissors have blunt tips. These grips are not optional, they are how you control what you are doing.
Start on a banana skin, it is forgiving. Make a small cut, then place 3 simple interrupted sutures. Enter at 90 degrees, pass evenly through both sides, and keep about 5 mm spacing. Get the motion right before it matters.
Move to the silicone pad, the pre cut slits feel more like real tissue. Place 3 simple interrupted sutures. Goal: edges meet without overlapping, spacing is even, knots lie flat.
The hardest part is the knot. First throw counterclockwise: wrap, grab, pull. Second throw clockwise: same motion, opposite direction. That makes a square knot, and it will not slip.
The oldest known sutures were found in an Egyptian mummy from around 1100 BCE. Surgeons used linen thread, and the technique was remarkably close to what you are learning today.
Every needle goes directly into the sharps container, never set down loose. Count your needles at the end: every one that went out must come back. Used suture material goes in the sharps container too. This is real OR protocol and it is non negotiable.
Using the rubric in your Casebook, score yourself 1 to 5 on spacing (even, about 5 mm), depth (consistent), tension (edges meet without blanching), and knot quality (flat and secure). Be honest, this is for your own improvement.
- Compare your first stitches to your last ones. What improved as you practiced? That improvement over 45 minutes is exactly how surgeons build skill, through repetition.
- Plan Sofia's treatment: what suture type and size would you use, how many stitches, and what would you say to calm her down?
- How does the doctor's suture choice compare to the plan you wrote?
- Why does bedside manner matter as much as technical skill in Sofia's case?
- Based on your self assessment, would you trust yourself to close Sofia's wound? What would you improve?
- What was the hardest part of learning to suture, and what made it hard?
- How did it feel to work with real surgical instruments for the first time?
- Would you want to be the person responsible for closing wounds in an emergency?
Closing a wound is daily work for a whole set of Valley careers. Watch an ER doctor's day, then talk it over with your partner.
Valley first step: a bachelor's, then medical school, then an EM residency. UCSF Fresno runs one of the oldest EM residencies in the West.
Pay, roughly: $300K and up.
Valley first step: a bachelor's, then PA school. UCSF Fresno hosts PA training and rotations in emergency medicine.
Pay, roughly: around $130K and up.
Valley first step: become an RN, then a Master of Science in Nursing, offered at Fresno State.
Pay, roughly: around $150K in California.
Valley first step: a bachelor's, medical school, then a surgery residency. Central Valley surgeons train at UCSF Fresno.
Pay, roughly: $350K and up.
Pick the two careers that pull at you. Which one could you start the fastest? Write one step you could take while you are still in high school, then share one with the class.
You handled real surgical instruments, tied a knot that will not slip, and learned that calming a scared patient matters as much as the stitch. Next you scrub in and learn the rules of the operating room.