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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