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  • Medical Students Training Program - Square Knot - Penn Surgery

    Загружено:

    Colin Cleary
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    The document describes how to tie surgical knots, specifically the square knot, which is the most common and reliable knot for closing incisions and tying off blood vessels. It provides step-by-step instructions for tying the knot using both two hands and one hand. The square knot is made by alternating the direction the suture strands pass over and under each other with each throw. Proper tension applied horizontally at the end ensures the knot lies flat.

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    Medical Students Training Program - Square Knot - Penn Surgery

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    The document describes how to tie surgical knots, specifically the square knot, which is the most common and reliable knot for closing incisions and tying off blood vessels. It provides step-by-step instructions for tying the knot using both two hands and one hand. The square knot is made by alternating the direction the suture strands pass over and under each other with each throw. Proper tension applied horizontally at the end ensures the knot lies flat.

    Авторское право:

    © All Rights Reserved
    Скачайте в формате PDF, TXT или читайте онлайн в Scribd
    Отметить как неприемлемый контент
    80 просмотров5 страниц

    Medical Students Training Program - Square Knot - Penn Surgery

    Загружено:

    Colin Cleary
    The document describes how to tie surgical knots, specifically the square knot, which is the most common and reliable knot for closing incisions and tying off blood vessels. It provides step-by-step instructions for tying the knot using both two hands and one hand. The square knot is made by alternating the direction the suture strands pass over and under each other with each throw. Proper tension applied horizontally at the end ensures the knot lies flat.

    Авторское право:

    © All Rights Reserved
    Скачайте в формате PDF, TXT или читайте онлайн в Scribd
    Отметить как неприемлемый контент
    из 5

    1/4/2015

    Medical Students Training Program - Square Knot - Penn Surgery

    SearchPennMedicine Search Penn Medicine

    Residencies

    Fellowships

    ClerkshipinSurgery200
    Education/Training
    SubInternships300
    VisitingStudents

    Applications

    Students

    Alumni

    CME

    TrainingProgram

    MEDICALSTUDENTS
    SquareKnot

    AgnewSociety

    TwoHandTechnique
    Thetwohandsquareknotistheeasiestandmostreliablefortyingmostsuturematerials.Itmay
    beusedtotiesurgicalgut,virginsilk,surgicalcotton,andsurgicalstainlesssteel.
    Standardtechniqueofflatandsquaretieswiththeadditionalthrowsifindicatedbythesurgical
    circumstancesandtheexperienceoftheoperatorshouldbeusedtotieBIOSYN(poliglecaprone
    25)suture,CoatedPOLYSORB(polyglactin910),TICTONpolyestersuture,SOFSILKsilksuture,
    andSURGIPROpolypropylenesuture.

    SutureNames
    Biosyn=Monocryl

    Polysorb=Vicryl

    Surgipro=Prolene

    Monosof=Ethilon

    Sofsilk=PermaHand

    Ticton=Ethibond

    Surgidac=Mersilene

    1. Whitestrandplacedoverextendedindexfingeroflefthandactingas
    bridge,andheldinpalmoflefthand.Purplestrandheldinrighthand.

    2. Purplestrandheldinrighthandbroughtbetweenleftthumbandindex
    finger.

    3. Lefthandturnedinwardbypronation,andthumbswungunderwhitestrand
    toformthefirstloop.

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    4. Purplestrandcrossedoverwhiteandheldbetweenthumbandindexfinger
    oflefthand.

    5. Righthandreleasespurplestrand.Thenlefthandsupinated,withthumb
    andindexfingerstillgraspingpurplestrand,tobringpurplestrandthrough
    thewhiteloop.Regrasppurplestrandwithrighthand.

    6. Purplestrandreleasedbylefthandandgraspedbyright.Horizontaltension
    isappliedwithlefthandtowardandrighthandawayfromoperator.This
    completesfirsthalfhitch.

    7. Leftindexfingerreleasedfromwhitestrandandlefthandagainsupinated
    toloopwhitestrandoverleftthumb.Purplestrandheldinrighthandis
    angledslightlytotheleft.

    8. Purplestrandbroughttowardtheoperatorwiththerighthandandplaced
    betweenleftthumbandindexfinger.Purplestrandcrossesoverwhit

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    strand.

    9. Byfurthersupinatinglefthand,whitestrandslidesontoleftindexfingerto
    formaloopaspurplestrandisgraspedbetweenleftindexfingerand
    thumb.

    10. Lefthandrotatedinwardbypronationwiththumbcarryingpurplestrand
    throughloopofwhitestrand.Purplestrandisgraspedbetweenrightthumb
    andindexfinger.

    11. Horizontaltensionappliedwithlefthandawayfromandrighthandtoward
    theoperator.Thiscompletesthesecondhalfhitch.

    12. Thefinaltensiononthefinalthrowshouldbeasnearlyhorizontalas
    possible.

    SquareKnot
    http://www.uphs.upenn.edu/surgery/Education/medical_students/square_knot.html

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    OneHandTechnique
    Whereverpossible,thesquareknotistiedusingthetwohandtechnique.Onsomeoccasionitwillbenecessarytouseonehand,either
    theleftorright,totieasquareknot.Theseillustrationsemploythelefthandedtechnique.
    Thesequenceofthrowsillustratedismostcommonlyusedfortyingsinglesuturestrands.Thesequencemaybereversedshouldthe
    surgeonbeholdingareelofsuturematerialintherighthandandplacingaseriesofligatures.Ineithercase,itcannotbetoostrongly
    emphasizedthatthedirectionsthehandstravelmustbereversedproceedingfromonethrowtothenexttoensurethattheknotformed
    landsflatandsquare.Halfhitchesresultifthisprecautionisnottaken.

    1. Whitestrandheldbetweenthumbandindexfingeroflefthandwithloop
    overextendedindexfinger.Purplestrandheldbetweenthumbandindex
    fingerofrighthand.

    2. Purplestrandbroughtoverwhitestrandonleftindexfingerbymovingright
    handawayfromoperator.

    3. Withpurplestrandsupportedinrighthand,thedistalphalanxofleftindex
    fingerpassesunderthewhitestrandtoplaceitovertipofleftindexfinger.
    Thenthewhitestrandispulledthroughloopinpreparationforapplying
    tension.

    4. Thefirsthalfhitchiscompletedbyadvancingtensioninthehorizontalplane
    withhtlefthanddrawntowardandrighthandawayfromtheoperator.

    5. Whitestrandloopedaroundthreefingersoflefthandwithdistalendheld
    betweenthumbandindexfinger.

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    6. Purplestrandheldinrighthandbroughttowardtheoperatortocrossover
    thewhitestrand.Continuehandmotionbyflexingdistalphalanxofleft
    middlefingertobringitbeneathwhitestrand.

    7. Asthemiddlefingerisextendedandthelefthandpronated,thewhite
    strandisbroughtbeneaththepurplestrand.

    8. Horizontaltensionappliedwiththelefthandawayandrighthandtoward
    theoperator.Thiscompletesthesecondhalfhitchofthesquareknot.Final
    tensionshouldbeasnearlyhorizontalaspossible.

    BacktoKnotTyingHomePage

    http://www.uphs.upenn.edu/surgery/Education/medical_students/square_knot.html

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