Материал: surgical knot tying manual covidien
Step 2.
Form the First Suture Loop
The first loop is formed by the tip of the left index finger that passes its suture end over the other suture end held by the right hand. As the tip of the left index finger passes its suture end over the suture end held by the right hand, the left thumb passes under (arrow) the suture end held by the right hand.
Step 3. Pass Thumb Up Through the Suture Loop
The tip of the left thumb advances up through the suture loop, replacing the tip of the left index finger.
Step 4.
Pass Free
Suture End
Over the Suture Loop
The free suture end, held by the right hand, is passed over (arrow) the suture loop.
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VIII. two-hand tie techniques — square knot (1=1) formation of the first throw (cont’d)
Step 5.
Pass Free Suture End Down
Through the Suture Loop to Form Single-Wrap Throw
After the suture end is grasped between the tips of the left thumb and index finger, the pinched suture end is passed downward through the suture loop. The right hand releases its free suture end so that it can
be passed down through the suture loop. The free suture end is regrasped between the tips of the right thumb and index finger to withdraw (arrow) it through the suture loop to form a single-wrap throw.
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Step 6.
Advance First Single-Wrap Throw to Wound Surface
With the suture ends grasped in the palms of the surgeon’s hands, the tips of the index fingers and thumbs position the suture ends in a direction (arrows) perpendicular to that of the wound. The surgeon applies constant tension to the suture ends, which advances the first single-wrap throw of the square knot to the surface of the wound. Advancement of the first throw is complete when the divided skin edges of the mid-portion of the wound are approximated.
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VIII. two-hand tie techniques — square knot (1=1) formation of the second throw
Step 7.
Begin Formation of the Second Suture Loop
The dorsum of the tip of the left thumb is passed under its suture end in order to direct it beneath (arrow) the other suture end that is held by the right hand. During formation of the second throw, constant tension is applied to the suture ends to maintain wound approximation.
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Step 8.
Form the Second Suture Loop
The left thumb advances its suture end beneath the other suture end to form a suture loop. The tip of the left index finger passes down (arrow) to touch the left thumb.
Step 9.
Pass Index Finger Down Through the Suture Loop
After the tip of the left index finger contacts the tip of the left thumb (tip- to-tip pinch), both are advanced down (arrow) through the suture loop so that only the tip of the left index finger remains in the loop.
Step 10.
Pass Free Suture End Under the Suture Loop
The free suture end held by the right hand is passed under the suture loop to be positioned (arrow) between the tips of the left index finger and thumb.
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