Instrument suture tying

After the suture is placed, it is tied using the needle holder as follows:
(A) Pull the suture through the wound and leave a tail about 1 inch (2.5 cm) long at the initial entry site. Drop the suture needle on the sterile field and close the empty needle holder.
(B) Place the closed needle driver along the axis of the wound between the 2 ends of the suture (repeat for each throw described below). For the first tie (throw), in the nondominant hand, grasp the suture on the side of the wound where the needle emerged about halfway between the needle and the wound site and wrap it twice (surgeon's knot) or once around the needle holder (square knot) being held in the dominant hand.
(C) Open the needle holder and grasp the tail end of the suture. Pull the tail end through the 2 loops and across the wound while moving the nondominant hand in the opposite direction across the wound. For a surgeon's knot (percutaneous suture) use 2 wraps and then pull the surgeon's knot flat to the skin with enough tension to gently evert the skin edges without strangulating the tissue. Release the tail. For a half knot (dermal suture), use one wrap (not pictured).
(D) Wrap the suture around the needle holder once in the opposite direction of the first 2 loops and pull the half knot so that it lies flat on the surgeon's knot.  
(E)  Repeat the half knot tie to place the suggested number of throws as determined by suture type and layer of closure.
(F) Cut the suture ends at the appropriate length (percutaneous knot: approximately the distance between the sutures; dermal knot: close to the last knot to minimize the amount of suture in the wound).
(G): Ensure even spacing by placing the initial suture in the middle of the wound. The next two stitches go on each side of the first stitch, midway between the center stitch and the wound corners. Additional bisecting stitches are placed until the wound is properly aligned.