Hi, this is Omni-Rut Westeism with Cape Town University Medicine. Today talking about basic suturing techniques and showing you three example sutures often used in suturing skin wounds. First, let's talk about the equipment that is required. The minimum equipment you will need to suture a wound is suture material. There are many different kinds of suture material available on the market and a full discussion of their pros and cons are outside the scope of this demonstration. Today we will use a nylon monofilament suture. You will also need a needle holder, a pair of scissors and either tooth or non-toothed foreseps depending on what's available. You will need local anesthetic to anesthetize the wound, some goes and a cleaning solution. After explaining the procedure to the patient, don universal precautions and proceed gently cleaning the external surface of the wound. Once this is been done, inject local anesthetic along the wound edges, approaching the wound from the wound side itself and not injecting through the skin. Make sure that the entire wound is anesthetized along both its lengths from edge to edge. Once the wound has been anesthetized, safely dispose of your shot and allow the local anesthetic enough time to work. After an appropriate passage of time, taste the wound edge and confirm that your anesthesia has been successful. It is now appropriate to clean the wound a bit more vigorously, including the inside of the wound and to rinse or irrigate the antiface any far more material. This should now cause less discomfort to the patient. Once the skin has been prepared, proceed to suturing. In this case, we are going to use a nylon monofilament suture. Open your suture, reveal the needle and grab the needle with your needle holder. Hold the needle about a third to a quarter from the back of the needle on the flat surface with a tip of the needle holder. This allows for an easier rotating motion of the wrist to take the needle through the skin. When suturing a wound, we suggest starting in the middle and then progressively halving the gaps in between to ensure even distribution of sutures. For a simple interrupted suture, insert the needle at 90 degrees to the skin and with a rotating motion of the wrist, simply twist the needle through. You could also insert on the one end, come out the another wound and insert again. Pull the suture material through, giving just enough to suture. There are many ways to tie an instrument not, one way is the following. Turn it twice around the instrument, grab the suture and pull it across the wound as such. Only enough force should be applied to approximate the wound inches and avoid excessive tension across the wound. Now rotate the material in the opposite direction around your instrument, grab the tip and tie another knot. Finally, two in the direction same as before and complete your knot. Seat the knot over one of the inter-edges and neatly turn the edges of the suture in the material. Another useful suture to use is a vertical mattress suture. A vertical mattress suture takes a bite of tissue that is slightly further and deeper than a simple interrupted suture initially as an initial throw. Reverse the direction of the needle on your instrument so that you can come back across the wound. To come back across the wound, go shallow and close to the wound edge, grabbing only a small piece of skin. Pull the suture material through until you have just enough to tie the knots. Not same as before, one two put it across, one put it across and finally one two and put it across. You will notice that the suture lies to the side of the wound with no material crossing it and that results in slight evasion of the wound edges which may promote wound healing. Finally, I will show you a pulley suture which is a variation on a vertical mattress suture and is an extremely useful suture when trying to suture a wound that gait widely or under a lot of tension. Position the needle correctly and start off with a vertical mattress suture as shown before. Deep and far, deep and far. Switch the position of the needle and now come back close and shallow and again close and shallow. If you were to complete the suture now, this would be a simple vertical mattress suture. Instead though, pass your needle through this preserved proximal skin loop represented on the vertical mattress suture as that, pass it through and now tie the knots two and pull one and pull two two pull turn the edges of the suture in the material. By passing the needle back through the proximal skin loop, you have created a pulley effect, allowing the physics of this configuration to spread the tension across the wound much more efficiently and close wounds even under a lot of tension much more efficiently. One potential useful pulley suture is to do the initial halving or maybe even the second halving and then fall in the race with simple interrupted sutures in a widely gaiting or high tension. That's it. Thank you very much.