Knot Tying Suture Patterns/Hand Ties

what is a Strangulating knot:

A strangulating knot is a ligature knot that tightens around tissue or a vessel under tension, producing circumferential compression and increased resistance to slippage.

When do we use Strangulation knot

o Uses: ligating large vessels or structures

What is Miller's knot

o Cross, under first pass

What is Modified Miller's knot

o Passes to the right, under both

What is Transfixing knot

oUsed to tie a structure to part of itself or another structure

What is Aberdeen knot

o A daisy chain to finish a line of suture on itself

What is a Autoligation knot

o Tying a knot with the tissue itself

o Suture-less

oSpecific circumstances only!

Which throws are intrinsically secure?

o Square

oSurgeon's

What are the suture type

o Elasticity and handling

▪ Mono vs multi

What do we mean by tissue type

o Friable tissue? Maybe nothing with shear

▪ Increased shear with surgeon's and strangulating

the characteristic Requires instrumentation (needle driver, etc.) when do we use

we use it during the instrument tie, not hand tie

the characteristiic is Better for deep spaces which method will we use

hand tie

the characteristic is Better tactile feedback of suture placement what kind of tie can we use

hand tie

the characteristic is Better for delicate structures what kind of tie can we use

instrument tie

the characteristic is Better tension control what kind of tie can we use

instrument tie

One handed tie

• Considered better for deeper spaces

• Considered "faster"

• First throw:

o Hold the "reins"

▪ Non-dominant hand wraps from below into hand

▪ Dominant hand drapes from above into hand

oPut both in dominant hand side by side

oUsing dominant hand, weave “over the under” and “under the over”

▪ (weave over the strand from the ND hand and under the D hand)

o Pull to make first knot – dominant hand down, non- dominant hand up

One handed tie: Second throw:

oYou hands should naturally want to go to the next position

o Hold the "reins" opposite

▪ Non-dominant hand drape from above

▪ Dominant hand drape from below

o Put both in dominant hand

oUsing dominant hand, weave over the over and under the under

o Pull to make first knot – dominant hand up, non- dominant hand down

Two handed tie (bare with me here)

• Considered better for tension control

• Considered "easier"

• Uses more suture

• First throw:

o Make finger guns with suture end facing down, draped over pointers

o Non-dominant hand- pinch thumb and pointer, roll suture to bottom on thumb by rotating hand away.

o Open pinch

o Place free-end from dominant hand next to non-dominant suture and pinch.

o Rotate fingers back toward you- will cross the suture lines towards patient.

o Open pinch, grab free end and pull through.

o Pull dominant hand down and non-dominant hand up.

General rules for suture patterns• Use the correct suture pattern for the task

• Create sturdy knots for security

• First bite on far side of wound

• Leave sufficient suture tags (minimum)

oInternally- 1 cm

o Externally- 1-2 cm

• Never cut until you are sure

• Suture knots never lie

How to choose? Interrupted:

oUses more suture

oSlower

oMore secure if knot/line breaks

How to choose? Continuous::

oUses less suture

oFaster

o Less secure if knot/line breaks

Simple Interrupted

Simple Interrupted

What is cruciate

▪ Two simple bites on alternating sides of wound

▪ Creates an "X" across when tied

What is Vertical Mattress

▪ Four complex bites on alternating sides of wound

▪ Creates a "railroad track"

What is Horizontal Mattress

▪ Four complex bites on alternating sides of wound

▪ Creates two parallel lines

When do we use Simple Interrupted

Skin closure, body wall closure, apposing two like-tissues, "tacking"

Characteristic of Simple Interrupted

o"easiest" pattern- foundational

oBites equal distance from wound and

equal distance apart

▪ 5 mm is goal

oFar bite, near bite, tie

oUtilizes the least amount of suture for

interrupted patterns

When do we use Interrupted Patterns: Cruciates

Skin closure, body wall closure, apposing two like- tissues

Interrupted Patterns: Cruciates

o"easiest" complex pattern- foundational

o "crossed simple interrupteds"

oBites equal distance from wound and equal distance apart

▪ 5 mm is goal

▪ Makes a square for each knot

o Far bite, near bite, far bite, near bite, tie