Fig. 33. A needle is passed in two steps. A. The needle is rotated posteriorly, and it enters the tissue surface in a perpendicular fashion (90-degree angle) and emerges perpendicular to the wound suture. B. The same angle of penetration is followed when the apposing tissue is entered perpendicularly and the needle again emerges at a 90-degree angle to the tissue surface. This method causes minimal shift of the wound surface when the suture is tied.