Tie the Knot

August 1, 2005

You've just finished suturing a laceration on a writhing, screaming toddler, and you notice that the knot is not tight enough.

You've just finished suturing a laceration on a writhing, screaming toddler, and you notice that the knot is not tight enough. Something must have slipped. To tighten things up a bit, run a loop between the first and last stitch on top of the skin, then cinch up both ends and tie (Figure). If this maneuver fails, you'll need to resuture the laceration.

--D. Brady Pregerson, MD
Los Angeles

Figure – These 3 photographs show the steps involved in a simple technique for tightening up sutures that have accidentally loosened during stitching. First, run a separate, unattached piece of suture under the first and last stitch (A). Grasp both ends of the suture (B), then cross them (C) as you prepare to cinch them up and tie.