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Real-time finite element (FE) analysis can be used to represent complex deformable geometries in virtual environments. The need for accurate surgical simulation has spurred the development of many of the new real-time FE methodologies that enable haptic support and real-time deformation. These techniques are computationally intensive and it has proved to be a challenge to achieve the high modeling resolutions required to accurately represent complex anatomies. We present a new real-time methodology based on linear FE analysis that is appropriate for a wide range of surgical simulation applications. A methodology is proposed that is characterized by high model resolution, low preprocessing time, unrestricted multipoint surface contact, and adjustable boundary conditions. These features make the method ideal for modeling suturing, which is an element common to almost every surgical procedure. We describe constraints in the context of a Suturing Simulator currently being developed.