TEALE FENNING

Nick Raine-Fenning · Posted: Sat Oct 20, 2007 7:13 pm Post subject: Surgical knots

The key principle to knot tying is to create a secure square knot that ultimately will not slip.

A complete square knot consists of two sequential throws that lie in opposite directions. This can be achieved in many different ways. A surgeon’s knot is a variation in which a double throw is followed by a single throw to increase the friction on the suture material and to decrease the initial slip until a full square knot has been completed.
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"Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997

Nick Raine-Fenning · Posted: Sat Oct 20, 2007 7:14 pm Post subject:

Techniques

There are three basic techniques of knot tying.

Instrument tie

This is the most straightforward and the most commonly used technique. You must cross your hands to produce a square knot; to prevent slipping, use a surgeon’s knot on the first throw only. Do not use instrument ties if the patient’s life depends on the security of the knot.
Hand tying has the advantage of tactile sensations lost when using instruments. There are two options:

One handed knot

This is an alternative to the surgeon’s knot, but must be followed with a square knot. To attain a square knot, the limbs of the suture must be crossed even when the knot is placed deeply.
The one handed technique is useful for the placement of deep seated knots and when one limb of the suture is immobilized by a needle or instrument.

Two handed knot

The two handed knot is the most secure. Both limbs of the suture are moved during its placement. A surgeon’s knot is easily formed using a two handed technique.
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"Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997

Nick Raine-Fenning · Posted: Sat Oct 20, 2007 7:14 pm Post subject:

How many throws?

A minimum of two complete square knots are required on any substantive vessel and generally more especially when a monofilament, or slippery, suture is used.

How long should you leave a suture when cutting it?

Slippery materials require longer ends than “non-slippery” materials. It is important to strike a balance between the need for knot security and the desire to leave as little foreign material in the wound as possible.
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"Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997

Nick Raine-Fenning · Posted: Sat Oct 20, 2007 7:15 pm Post subject:

Principles of teaching knot tying:

Demonstrate the whole skill of tying a knot

Demonstrate each step.

Let the learner practice each step.

Watch carefully and reinforce the correct actions, while making suggestions to correct problems.

Once each step is mastered, the learner should put them together to tie a complete knot on his/her own.

Then it is all about practice, practice, practice!
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"Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997