Knot Tying

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Knot Tying

• SURGICAL SKILLS

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The KNOT is the weakest link of the suture and
therefore must be tied properly
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Consequences of Poorly Tied Knot
1.Vessel Bleeding 2.Fascial Dehiscience 3.Incision
al Hernia 4.Superficial Wound Dehiscience
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10 COMMANDMENTS

• 1.Tie the simplest knot allowable for the suture
  material.
• 2. Knots should be as small as possible to avoid
  excessive tissue reaction.Cut tails short.
• 3. Avoid Friction between 2 strands when tying (
  SAWING),weakens the material.

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10 COMMANDMENTS

• 4. Avoid damaging Suture materials by crushing
  with an instrument.
• 5. Avoid excessive tension on sutures.Do not try
  and over compensate for a poor first
  throw.Practice with finer sutures.
• 6. Sutures used for tissue approximation should
  not be tied too tightly tissue ischemia.

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10 COMMANDENTS

• 7. After the first throw is placed maintain
  tension on the end of the strand to avoid
  loosening and creation of an AIR KNOT.
• 8.Final tension on any throw on a knot should be
  in a horizontal direction.
• 9. Change your position in relation to the
  patient prn to ensure knots go down securely and
  flat.

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10 COMMANDMENTS

• 10. Extra throws do not add strength to the
  properly tied knot.

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Square Knot

• SquareLoop and Ear exit on same side of the Knot
• GrannyLoop and Ear exit on opposite sides of the
  Knot

Granny knot inherently weaker
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Square Knot

• Tails must be pulled in horizontal direction to
  lay throw flat
• Next throw direction of hands must be reversed
• Hand direction not reversed becomes more of a
  slip knot

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Surgeons Knot

• Double loop 1st throw.
• Does not improve strength ,but prevents slippage

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Tips for Knot Tying

• Right Handed surgeons tie with their left hand.
• Reverse hand directions for each throw to allow
  knots to lie flat and avoid a series of half
  hitches.
• Instrument ties are useful when one or both ends
  of a suture are short.
• Surgeons knot is useful if the knot is under
  tension.

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Todays Procedures

• Instrument Tie
• One hand Tie
• Two Hand Tie
• Surgeons Knot