The needle is held by a needle holder. The angle and distance from needle tip varies based on the surgeon’s preference. The needle holder should be tightened, but not excessively to prevent damage to both the holder and needle. The needle is held in vertical position and it is longitudinally perpendicular to the holder. Incorrect placement of the needle in its holder may cause problems. The problems include difficult skin penetration, bent needle, and improper entry in skin tissue.
The tissue has to be sterilized to let suture placement be proper. Based on the preference of the surgeon, skin hooks, forceps can be used to hold the tissue gently. The tissue that is being sutured should not be subjected to excessive stress to diminish risk of tissue strangulation.
Forceps are required for needle grasping when it exits tissue post a pass. Prior to removing the needle holder, holding and stabilizing the needle will be required. This maneuver reduces risk of losing a needle in the dermis. This is required when small needles are deployed in the back and big needle bites are required for apt tissue approximation.
The needle has to penetrate skin at 90° angle as it reduces entry wound size and promotes skin edge eversion. This needle has to be inserted 1-3 mm away from skin edge, but this can vary on skin thickness. The angle and depth of the suture varies on the specific suturing technique. Both sides of the suture should be like mirror images. The needle must exit the skin while being perpendicular to the surface of the skin.