Chapter 8 / Surgical Knot Tying 61
C h a p t e r 8
Surgical Knot
Tying
KNOTS AND EARS
What is the basic surgical |
Square knot |
knot? |
|
What is the first knot that |
Instrument knot |
should be mastered? |
|
What is a “surgeon’s knot”? |
Double-wrap throw followed by single |
|
square knot throws |
How many (correct) throws |
As many as the attending surgeon wants |
are necessary to ensure that |
|
your knots do not slip? |
|
What are the guidelines for |
Depends on the suture material |
the number of minimal |
Silk—3 |
throws needed? |
Gut—4 |
|
Vicryl®, Dexon®, other braided |
|
synthetics—4 |
|
Nylon, polyester, polypropylene, |
|
PDS, Maxon—6 |
62 Section I / Overview and Background Surgical Information
How long should the ears of the knot be cut?
Some guidelines are:
Silk vessel ties—1 to 2 mm Abdominal fascia closure—5 mm Skin sutures, drain sutures—5 to
10 mm (makes them easier to find and remove)
When should skin sutures be As soon as the wound has healed enough
removed? |
to withstand expected mechanical |
|
trauma |
|
Any stitch left in more than 10 days will |
|
leave a scar |
|
Guidelines are: |
|
Face—3 to 5 days |
|
Extremities—10 days |
|
Joints—10–14 days |
|
Back—14 days |
|
Abdomen—7 days |
How can strength be added |
With Steri-Strips® |
to an incision during and |
|
after suture removal? |
|
In general, in which group |
Patients on steroids |
of patients should skin |
|
sutures be left in longer |
|
than normal? |
|
How should the sutures |
Use the tips of the scissors to avoid |
be cut? |
cutting other tissues |
|
Try to remove the cut ends (less foreign |
|
material decreases risk of infection) |
|
Rest the scissor-hand on the non–scissor- |
|
hand to steady |
How is an instrument knot tied?
Always start with a double wrap, known as a “surgeon’s knot,” and then use a single wrap, pulling the suture in the opposite directions after every “throw”
Does a student need to know a one-hand tie?
No! Master the two-hand tie and the instrument tie
Chapter 8 / Surgical Knot Tying 63
INSTRUMENT TIE
1.
6.
2. |
7. |
3.
8.
4.
9.
5.
Then continue with single throws
64 Section I / Overview and Background Surgical Information
TWO-HAND TIE
What is the basic position for the two-hand tie?
“C” position, formed by the thumb and index finger; the suture will alternate over the thumb and then the index finger for each throw
How is a two-hand knot |
First, use the index finger to lead |
tied? |
|
Chapter 8 / Surgical Knot Tying 65
Then use thumb to lead:
Ask a resident or intern to help you after you have tried for a while. Open book to this page for guidance.
Place the Surgical Recall bookmark at back of book to use as a suture anchor.