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Surgical Knot Tying Manual

Third Edition

Surgical Knot Tying Manual

Third Edition

Richard F. Edlich, M.D., Ph.D.

Distinguished Professor of Plastic Surgery,

Biomedical Engineering and Emergency Medicine

Founder of DeCamp Burn and Wound Healing Center

University of Virginia Health System

Director of Trauma Prevention, Education and Research

Trauma Specialists, LLP, Legacy Emanuel Hospital

Portland, Oregon

William B. Long III, M.D.

President and Medical Director, Trauma Specialists, LLP,

Legacy Emanuel Hospital

Portland, OR

forward

If this manual heightens only perceptibly students, nurses, nurse practitioners, physician assistants, surgical residents

and surgeon’s interest in the biology of wound closure and infection, the long years occupied in my search for improved methods of wound management would more than fulfill my expectations. However, another important purpose of this manual is to honor

my colleagues, who collaborated in our clinical and experimental research investigations. It is a duteous pleasure to acknowledge the great help that I have received from Dr. George T. Rodeheaver, Distinguished Research Professor of Plastic Surgery, University of Virginia Health System and Dr. John G. Thacker, Vice-Chairman of the Department of Mechanical and Aerospace Engineering, University of Virginia, who have made numerous scientific contributions to my studies of wound closure. Dr. Thacker and Dr. Rodeheaver are excellent teachers who provide the insight and imagination that solve the most challenging problems. It is also important to note that studies have been undertaken with gifted surgeons in Trauma Specialist, LLP who have developed the only

verified Level I Trauma Center in the Pacific Northwest. Dr. William B. Long III, President and Medical Director of Trauma Specialists, LLP, of Legacy Emanuel Hospital has played an instrumental role in evaluating the performance of surgical products for trauma care that are used throughout the world.

Richard F. Edlich M.D., Ph.D.

table of contents

I.

Individualized Self-Instruction

1

II.

Introduction

2

III.

Scientific Basis for Selection of Sutures

4

1. Nonabsorbable Suture

5

 

2.

Absorbable Suture

12

IV.

Components of a Knotted Suture Loop using

 

 

either a Granny Knot Type or a Square Knot Type

22

V.

Mechanical Performance

28

 

1.

Knot Slippage

30

 

2.

Knot Breakage

31

 

3.

Suture Cutting Tissue

32

 

4.

Mechanical Trauma

33

VI.

Tying Techniques

34

 

1.

Instrument Tie

37

 

2.

Hand Tie

39

VII.

Essential Elements

42

VIII.

Two-Hand Techniques

44

 

1.

Square Knot (1=1)

44

 

2.

Surgeon’s Knot Square (2=1)

52

 

3.

Slip Knot (S=S)

62

IX.

One-Hand Technique

 

 

1.

Square (1=1)

70

X.

Instrument-Tie Technique

 

 

1.

Square Knot (1=1)

78

XI.

Selection of Suture and Needle Products

86

XII.

References

87

I. individualized self instruction

The root origin of the word education is educare or to anglicize it, edu-care. The meaning of education, therefore, is to care for, to nourish, to cause to grow. This being their ultimate

responsibility, teachers of surgery should be the most responsive component of the instruction system. Numerous other pressing clinical and administrative commitments, however, often limit interactions with the medical students, nurses, nurse practitioners physician assistants, surgical residents and surgeons. Consequently, learning difficulties may not be identified.

This manual was designed to be a self-instructional teaching aid for the medical student, resident, and surgeon providing an individualized environment of learning. For convenience, each page of this manual has wide margins to accommodate personal thoughts and further clarification. This manual is bound in a ring binder so that it lies flat, a prerequisite for any knot tying manual. The reader should take as little or as much time as needed to digest the information and to develop the illustrated psychomotor skills. At the end of this instruction, you should feel considerably more comfortable in understanding the science of tying surgical knots. More importantly it is our hope that this manual will inspire, motivate, and encourage creativity and self-direction in your study of the biology of wound repair and infection.

This Knot Tying Manual is available online at www.covidien.com/syneture.

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