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Instrument and Handed Knot in modern surgery PowerPoint Presentation

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Description : Instrument and Handed Knot in modern surgery

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Published on : Nov 14, 2020 | Views : 2368 | Downloads : 11

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Slide 1-

Instrument and Handed Knot Dr Mosa Alzahrani
Slide 2-

Introduction General Principles Types of Knots Types of techniques
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The purpose of knots is to join the two ends of the suture in a secure but gentle way More than 1,400 different types of knots described in THE ENCYLCOPEDIA OF KNOTS Only a few are used in modern surgery.
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The completed knot must be firm, and so tied that slipping is virtually impossible. The knot must be as small as possible to prevent an excessive tissue reaction, Ends should be cut as short as possible. Extra ties do not add to the strength of a properly tied knot. They only contribute to its bulk. Friction between strands must be avoided as this can weaken the integrity of the suture. Avoid damage to the suture material when handling (crushing or crimping) by surgical instruments (needleholders / forceps) GENERAL PRINCIPLES OF KNOT TYING
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Excessive tension applied by the surgeon will cause breaking of the suture and may cut tissue. Sutures should not be tied too tightly, because this may lead to tissue strangulation. After the first loop is tied, it is necessary to maintain traction on one end of the strand to avoid loosening of the throw if being tied under any tension. Final tension on final throw should be as nearly horizontal as possible. Do not hesitate to change position in relation to the patient in order to place a knot securely and flat. GENERAL PRINCIPLES OF KNOT TYING
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knot has three components
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INSTRUMENT TIE Using needle holder ONE- HANDED & TWO-HANDED TIE Using fingers
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Overhang knot Square knot / reef knot Surgeon’s knot Slip (or) Granny knot Types of knots
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The greatest precision in maintaining constant tension on the suture during the tying process Preferred by most surgeons (especially when others are tying) Easier of the techniques to master successfully More reliably produces square knots If you want to be a surgeon, master this technique Two Handed Tie
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The one-handed knot is so named because all of the maneuvering, including releasing and re-grasping the free end, is done with one hand. The other hand merely holds the fixed segment taut. One handed knots have the advantage of allowing more speed in tying, but have less tension control of the segments. More difficult to achieve excellent square knots. Unforgiving of lapses in technique. One Handed Tie
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Most surgical knots in skin and so t tissue reconstruction are tied using an instrument tie. This is generally the astest approach and also a ords the least amount o suture material waste. The needle holder is placed parallel with the incision (or vessel) being tied. The long end of the suture is wrapped around the tip of the needle holder in a clockwise direction forming a loop. The short end of the suture is grasped with the needle holder and pulled through the loop. Bring the short end of the suture toward you. This creates the first hitch of a square knot. The second hitch is formed by wrapping the long end of the suture around the instrument in a counterclockwise direction. The short end of the suture is then grasped and pulled through the loop. Pull the needle holder away from you, squaring the knot. Instrument Tie
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