Surgical knots

Definition:

A knot is the beginning and the end point of any suture.

Generalities

The execution of three overlapping components it is mandatory:

1st tie = tightening; 2nd tie = supporting; 3rd tie = security.

Extra ties do not add to the strength of a properly tied knot. They only contribute to its damage.

General principles in making a knot:

We have to reverse hands direction

We have to keep permanent and equal tension in both threads The knot must be lead using the fingertips

Also it must be progressively tightened

What makes a knot a good one

A well done knot has to: Be tight
The bigger the threads diameter is, the less secure the knot will be

Be as small as possible
Minimize the inflammatory reaction

Not slip Be resistant to traction

Applied tension depends on the thickness of the thread

Have the ends as short as possible:

absorbable - 6 mm non-absorbable - 3mm

Mistakes we often do
Friction between wires = lost integrity of the material Handling the suture material with a surgical instrument

Except when grasping the free end of the wire during an instrument tie

Excessive tension on a knot Extra ties

What do we need?
Wires; Scissors; Forceps/ Needle holder

Types of knots
1.The square knot 2.The surgeons knot 3.The forceps/instrument tie 4.Half Hitch Knot

1. The square knot

Most often used knot

It can be made: On hand On instrument It has the ends on the same side where they were when we started;
Its used for tying most of the types of surgical threads

2.The surgical knot

Can be made
On hand On instrument

The first tie - double; Sailors knot/ friction; Asymmetric; This knot is not getting loose during the execution of the second tie

3. Instrument tie

Its made with the needle holder or Pean forceps We can make:
A square knot A knot with multiple loops

Its hard to be performed in deep tissue If its properly done its a good quality knot Usually its made where there is not needed a lot tension in the wound

Square knot on instrument

Square knot on instrument

Square knot on instrument

Square knot on instrument

4.Half-Hitch knot

Used for deep ligatures Its based on sliding the loops on a thread which is holded in tension: The sliding is always made with the index The second hand holds the free end of the thread in tension The tightening is made in his depths A third tie is made for the security and the maintenance of the first two

Half-Hitch Knot

Half-Hitch knot

Take home messages

4 knots:
Square Surgeons On instrument Half-hitch

Proper execution We must make them fast, with precision without interrupting the main surgeon.

Thank you!!!