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General Principles of Knot Tying |
| The type of knot tied will depend upon the material used, the depth and location of the incision and the amount of stress that will be placed upon the wound post-operatively |
| Multifilament sutures are generally easier to handle and tie than monofilament sutures |
| The surgeon must work slowly and meticulously |
| Speed in knot tying frequently results in less-than-perfect placement of the strands |
| When tying a knot, the surgeon must consider the amount of tension he or she is placing upon the incision and must allow for post-operative edema |
| The General Principles of knot trying which apply to all suture materials are : |
| 1. The completed knot must be firm to virtually eliminate slippage |
| 2. The simplest knot for the material used is the most desirable |
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3. Tie the knot as small as possible and
cut the ends as short as possible This helps to prevent excessive tissue reaction towards absorbable sutures and to minimize foreign body reaction to non-absorbable sutures |
| 4. Avoid friction. "Sawing" between strands may weaken suture integrity |
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5. Avoid damage to the suture material
during handling, especially when using surgical instruments in instrument ties |
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6. Avoid excessive tension which may break
sutures and cut tissue This practice will lead to successful use of finer gauge materials |
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7. Do not tie sutures used for tissue
approximation too tightly, as this may contribute to tissue strangulation. Approximate-- do not strangulate |
| 8. Maintain traction at one end of the strand after the first loop is tied to avoid loosening of the throw. |
| 9. Make the final throw as nearly horizontal as possible |
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10.Do not hesitate to change stance or position
in relation to the patient inorder to place a knot securely and flat |
| 11.Extra throws do not add to the strength of a properly tied knot but only adds to its bulk |
| Some procedures involve tying knots with the fingers, using one or two hands ; others involve tying with the help of instruments. Perhaps the most complex method of knot tying is done during endoscopic procedures, when the surgeon must manipulate instruments from well outside the body cavity |
