Surgical Knot Tying - Podcast Version 0:00 / 0:00 1x 0.25x 0.5x 0.75x 1x 1.25x 1.5x 1.75x 2x Surgical knots have a wide variety of uses in surgery and knot tying is an essential skill for every surgeon to know and to be competent in. A completed knot should be firm, such that slipping of the knot is nearly impossible. However, excessive tension applied through a knot can cause damage to both the suture and the tissue, which can lead to poor wound healing and tissue necrosis. Each knot should be as small as possible, as to reduce any foreign body reactions. In this article, we shall look at the two major techniques for knot tying – the single handed tie and the tie at depth. Single Handed Knot Tie The square surgeons knot is the most reliable and well-known for nearly all suture materials. Procedure Start with the short thread facing upwards and the long thread facing downwards Pick up the end of the short thread with the L thumb and ring finger, with the remainder of the thread passing over the L index and middle fingers. Pick up the end of the long thread with the R thumb and index finger Bring up the long thread with the R hand, to align next to the short thread Using the L middle finger, whilst still holding the end between L thumb and ring finger, pass the short thread under and then over the long thread Pull the R hand upwards and the L hand downwards, allowing the knot to rest in position; adjust the tension of the knot as necessary Come back upwards with the short thread, by holding the end with the L thumb and index finger. Pick up the long thread with the R thumb and index finger and bring downwards, to align next to the short thread Repeat the same manoeuvre as before, passing the short thread under and over the long thread Pull the L hand upwards and the R hand downwards, allowing the knot to rest in position; adjust the tension of the knot as necessary Repeat the same manoeuvre as before with the short thread facing upwards and the long thread facing downwards Adjust the final tension of the knot as necessary Tying at Depth Tying at depth is used for knot tying deep within a body cavity. It is essential the knot is tied firmly to avoid slipping, whilst upwards pressure is avoided to prevent tearing of the tissue. Procedure Start with the short thread facing upwards and the long thread facing downwards Outside of the cavity, pick up the end of the short thread with the L thumb and ring finger, with the remainder of the thread passing over the L index and middle fingers. Pick up the end of the long thread with the R thumb and index finger Bring up the long thread with the R hand, to align next to the short thread Using the L middle finger, whilst still holding the end between L thumb and ring finger, pass the short thread under and then over the long thread Pull the R hand upwards and the L hand downwards Whilst holding tension in the long thread with the R hand outside the cavity, push the knot down with the L index finger past where the knot is needed to lie inside the cavity Come back upwards with the short thread, by holding the end with the L thumb and index finger. Pick up the long thread with the R thumb and index finger and bring downwards, to align next to the short thread Repeat the same manoeuvre as before, passing the short thread under and over the long thread Pull the R hand upwards and the L hand downwards Whilst holding tension in the long thread with the R hand outside the cavity, push the knot down with the L index finger past where the knot is needed to lie inside the cavity Repeat the same manoeuvre as before with the short thread facing upwards and the long thread facing downwards Adjust the final tension of the knot as necessary, by pushing past the knot. Frequent questions What are the essential skills required for surgical knot tying? Surgical knot tying is a fundamental skill for surgeons, involving techniques that ensure knots are firm and secure to prevent slipping. Proper technique is crucial to avoid excessive tension that could damage sutures or surrounding tissues. What is the square surgeon's knot and why is it commonly used? The square surgeon's knot is the most reliable knot for various suture materials, known for its security and stability. It is essential in surgical procedures to maintain tissue integrity and promote effective wound healing. How should tension be managed when tying surgical knots? Tension must be carefully managed while tying surgical knots to ensure they are secure without causing damage to the suture or tissue. Excessive tension can lead to complications such as poor wound healing and tissue necrosis. What is the technique for tying a knot at depth within a body cavity? When tying a knot at depth, it is crucial to maintain firm tension while avoiding upward pressure to prevent tissue tearing. The process involves manipulating the threads outside the cavity and carefully pushing the knot into position. Why is it important to keep surgical knots small? Keeping surgical knots small is vital to reduce the risk of foreign body reactions and complications during healing. Smaller knots minimise the impact on surrounding tissues, promoting better surgical outcomes. Rate This Article