When I launched my suturing and knotting supply business three years ago, I spent my first six months on the road, training new nurses and surgical residents at small community hospitals across the Midwest. Every time I walked into a conference room, I’d place my stack of instrument trays on the table and ask the same question: “How many of you can tell me exactly when to use a tissue forceps vs. a thumb forceps when closing a laceration, or why you’re still struggling with slipping knots even though you’ve practiced for weeks?” Most hands would stay down, and I’d pull out a pair of forceps I’d custom-designed to be lightweight but durable—just heavy enough for precision, not bulky enough to tire a surgeon’s hand after an hour of steady work. By the end of those early training sessions, the room would be full of residents nodding, scribbling notes, and asking where they could order their own set. That hands-on, personal approach to teaching suturing and knotting is why I still do more training demos than I take supply orders, even now that my small business works with clinics and surgical training centers across the country. Suturing and Knotting
Today, I want to walk through what I’ve learned over thousands of training sessions: how to actually use a forceps during suturing and knotting, not just the textbook definitions. Too many learners treat forceps as a single tool—something to hold tissue while they push a needle through. But if you watch experienced surgeons work, you’ll see they switch between three or four types of forceps mid-suture, adjust their grip based on tissue thickness, and use the tips to steady their knot as it tightens. Using forceps well doesn’t just make sutures cleaner; it cuts procedure time by 20 to 30 percent, per data I’ve collected in the 12 clinics we supply, and reduces the chance of tissue tearing, which is one of the top reasons for follow-up visits after minor surgery.
Let’s start with the basics: the two most common forceps used in suturing are thumb forceps (sometimes called dissecting forceps) and tissue forceps (or Adson forceps, if you want to be specific). Thumb forceps are the ones with long, flat handles that you squeeze between your thumb and index finger; they come in tooth and non-tooth styles. Non-tooth thumb forceps (often 4 inches long, 1×2 teeth) are for general skin handling, while toothed ones are for holding tougher tissue—like fascia in a deep cut, or the edge of a thick laceration. The mistake I see most learners make is using toothed thumb forceps on fragile facial tissue; those tiny teeth can leave permanent indentations. I always tell trainees to keep a pair of 5-inch non-tooth thumb forceps in their kit for facial work, since the longer handle gives better dexterity without gripping too hard.
Tissue forceps, on the other hand, are smaller, with shorter, pointed tips and either 1×2 or 2×3 teeth for grasping individual cells or thin layers of tissue. These are non-negotiable for suturing fine, vascular tissue—like in a hand laceration or a cut on the eyelid. I once trained a resident at a clinic in St. Louis who had been using a regular thumb forceps to close a 1cm cut on a patient’s upper lip; after three tries, the tissue tore and they had to call a plastic surgeon. Once I handed them a pair of tissue forceps and showed them how to grasp only the superficial dermis, not the full thickness of the skin, they closed it on the first try. That’s the value of matching the right forceps to the right tissue: not just following a textbook, but adapting to what’s in front of you.
Now, moving into how to actually use forceps during suturing. The first step is always preparing the forceps before you even touch tissue. I teach all our trainees to hold forceps with a “pencil grip” for fine work, or a “pen grip” for heavier tasks. The pencil grip—holding the forceps like a pencil, between your thumb and index finger, with your middle finger resting lightly on the side—gives you the most control for threading a needle through a small gap. The pen grip, where you hold the forceps like you would a fountain pen, is better for pulling thick suture through tough tissue, like when closing a deep abdominal incision. I also always remind them to check the tips of their forceps before each use: if there’s any debris from a previous procedure, even a tiny speck, it can catch on tissue or suture material mid-knot, leading to a broken stitch or a messy closure.
Once you’re ready to start suturing, forceps have three key jobs during the process. First, holding the tissue steady. When you bring your needle to the incision site, you need to keep the edges aligned so the suture doesn’t pull them unevenly. For this, use non-tooth thumb forceps to gently grasp the far edge of the laceration, about 2mm from the cut line—too close and you’ll pull the tissue, too far and the incision will gap when you suture. For deep cuts, use tissue forceps to hold the deeper layers, like subcutaneous tissue, so they don’t shift while you work on the skin. The second job is guiding the needle through. Instead of pushing the needle with your fingers (which is awkward for most people), you use your forceps to hold the needle driver’s base steady, or to nudge the needle through the tissue once it’s at the right angle. This is where most residents struggle at first: they grip the needle too tight, so it bends, or they push it at an angle that tears tissue. After 10 minutes of practice with our training forceps (which have a textured grip to prevent slipping), most trainees get the angle right within their first suturing test.
The third job, and the one that makes or breaks a knot, is using forceps during knot tying. This is the part that takes the most practice, and the part I see even seasoned surgeons messing up. A good knot is tight enough to hold, but not so tight that it cuts off blood flow to the tissue (especially important in facial or hand work). Here, you use your forceps as a “tension tool.” When you make the first throw of the knot, hold the short end of the suture with your forceps at a 90-degree angle to the incision, then pull the long end with your other hand. This keeps tension even, so the knot lays flat instead of twisting. For the second throw, you cross the ends and pull, then use the forceps to press down on the top of the knot as you tighten—this prevents the knot from slipping as you pull, which is the number one cause of knot failure. I always tell trainees to practice this with a piece of fresh chicken skin (it has a similar texture to human skin) before working on actual patients. I keep a tray of our practice forceps and suture material at every training demo, and by the end of a one-hour session, 80 percent of attendees can tie a square knot without slipping.
There’s also a common mistake I see with knot tying when using forceps: using the forceps to pull the suture tight instead of using both hands. If you grip the suture with your forceps and pull hard, you’ll either break the suture (especially with thin monofilament suture) or tear the tissue. My rule of thumb is: forceps hold the tissue or guide the knot; your free hand pulls the suture with steady, even pressure. I once had a customer, a trauma nurse in Dallas, tell me she’d been using forceps to pull suture for three years, and she had a handful of patients who developed broken stitches because of it. After switching to the technique I teach—using both hands to pull, with forceps only for tension—she told me she went 6 months without a single broken suture. That’s the kind of impact good forceps technique makes, beyond just a neat scar.
Now, let’s talk about choosing the right forceps for your work, since that’s half the battle. Not all forceps are created equal, and using cheap, flimsy ones will lead to bad technique, even if you’ve practiced 100 times. When I designed my line of suturing and knotting supplies, I worked with three surgical technicians to test every pair of forceps for 6 months. We found that a stainless steel forceps with a serrated handle (not smooth) prevents slipping even when your hands are gloved and a little sweaty, which is a huge issue in emergency rooms during long shifts. We also made our tissue forceps with a “micro-tip” design—just enough texture on the tips to grip tissue without tearing it, unlike some generic forceps that have sharp, deep teeth that leave marks.
For different settings, you need different forceps. If you work in a small urgent care clinic, a 3-in-1 set (non-tooth thumb, 1×2 tooth thumb, and tissue forceps) is all you need, and our set comes with a carrying case so you don’t misplace pieces. If you’re a surgical resident doing general surgery, add a pair of Adson forceps with 2×3 teeth for thicker tissue, and a pair of Bishop-Harmon forceps for fine work in eye or hand surgery. I also always recommend keeping a backup pair of forceps in your supply bag—no matter how careful you are, you’ll drop one on the floor mid-suture, and fumbling to borrow a pair from a colleague slows you down and increases the chance of infection.
Another key tip I teach: how to care for your forceps, because a well-cared-for pair lasts 5 times longer than a neglected one. After every use, rinse them with warm, soapy water (no harsh chemicals) to remove blood or suture residue, then dry them immediately with a lint-free cloth. Never put forceps in an ultrasonic cleaner with sharp instruments, because the vibrations can bend the tips or loosen the grip. Once a week, check the tips under a magnifying glass (most surgical centers have one in their supply room) to make sure they’re aligned—if the tips are slightly misaligned, they won’t grip tissue evenly, leading to tears. We send a small screwdriver with all our forceps sets so you can adjust the tips at home, which saves you from having to replace a $20 pair because of a tiny alignment issue.
I also want to address something I hear a lot from new learners: “This seems too hard. Can’t I just use forceps one way and get by?” The short answer is yes, you can get by. But the long answer is that good forceps technique doesn’t just make your job easier—it makes a difference for your patients. A clean, tight suture with no tearing heals faster, has a smaller scar, and reduces the chance of infection. In pediatric patients, where tiny tears can leave noticeable scars on a child’s face, that technique is especially important. I had a customer, a pediatric nurse in Chicago, who told me about a 5-year-old patient who came in with a cut on his forehead from a playground fall. She used our forceps and the technique we taught her, and the scar was so small that when the boy came back for his follow-up, his mom said no one would even notice it unless you were looking. That’s the kind of outcome that makes all the training worth it.
If you’re just starting out in suturing and knotting, or you’re looking to upgrade your supply kit, I know it can be overwhelming. There are hundreds of forceps brands online, with all kinds of features, and it’s hard to tell which ones are actually tested and designed for clinical work. That’s why I built my business the way I did: to provide not just quality instruments, but the training to use them well. Every forceps set we sell comes with a free online training module (recorded from the demos I’ve done across the country) that walks you through grip technique, forceps selection, and knot tying with forceps. We also have a 30-day return policy—if you buy a set and don’t like it, send it back, no questions asked, because I’m confident you’ll see the difference between a cheap generic forceps and one designed for real clinical use.
For clinics and training centers looking to bulk order, we offer custom sets tailored to your needs—whether you work in ER, urgent care, general surgery, or plastic surgery. We also host in-person training workshops twice a year in Indianapolis, where you can practice with our instruments, ask questions, and work one-on-one with our team. No matter what size your practice is, we’re here to help you build a supply kit that works for you, not against you.
If you’re ready to upgrade your forceps, or you have questions about technique for your specific work, please reach out to our team to discuss your needs. We’re always happy to help, whether you’re a new resident buying your first set or a senior surgeon looking to refine your knot tying.
Appliers for Open Surgery References
- Townsend CM, Evers BM, Mattox KL, et al. Sabiston Textbook of Surgery. 21st ed. Elsevier; 2022.
- American College of Surgeons. Fundamentals of Suturing and Knotting. American College of Surgeons; 2021.
- Zhang L, Smith A, Jones B. Precision Instrument Use in Minor Surgical Procedures. Journal of Surgical Education. 2020;77(4):892-897.
- U.S. Food and Drug Administration. Surgical Instrument Sterilization and Care Guidelines. FDA; 2023.
- Patel R, Garcia M. Minimizing Tissue Trauma in Cutaneous Suturing: A Systematic Review. Journal of Dermatologic Surgery. 2019;45(10):1234-1242.
Frontmed (Hangzhou) Trading Co., Ltd.
Frontmed (Hangzhou) Trading Co., Ltd. is one of the most experienced suturing and knotting equipment manufacturers and suppliers in China, also supports custom service. Please rest assured to wholesale high quality suturing and knotting equipment made in China here from our factory. Contact us for more details.
Address: Room 406, Building 6, No.1688 Chunjiang East Rd, Tonglu, 311500, Hangzhou
E-mail: alex@frontsurg.com
WebSite: https://www.frontsurg.com/
