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1、A knot-tying primer ETHICON, 1D 01.04, No. 62 Impressum Editor ETHICON Products Germany Robert-Koch-Strae 1 22851 Norderstedt Consultant Priv.-Doz. Dr. med. Friedrich-Christian Riess Cardiac Surgery Albertinen-Krankenhaus Hamburg Concept & Design RIESSmedien, Norderstedt Communication for medicine,
2、science and technology Photographs and art design Andreas Riess A knot-tying primer Foreword With this new revised edition of our “Knot-tying primer”, Ethicon would like to give those studying and commencing their career in medicine instructions to assist them in learning the most important knots an
3、d suturing techniques of modern surgical practice. We have limited ourselves quite deliberately to those techniques which are helpful for those at the start of their career to master. Further techniques, which the surgeon learns in the course of his professional practice, are not the subject of this
4、 publication. We hope that our information brochure is of use to you and wish you every success in your professional practice. Norderstedt, April 2003 3 5 Contents 1Knots7 1.1 Square knots, one-hand technique815 1.2 Square knots, two-hand technique1623 1.3 Instrument knots2427 2Suture techniques29 2
5、.1Subcutaneous sutures30 2.1.1 Subcutaneous suture using interrupted sutures31 2.1.2 Subcutaneous suture using a continuous suture31 2.2Suture of asymmetrical wounds32 2.2.1 Joining wound edges of different length32 2.2.2 Closure of larger wound areas33 2.3.Skin sutures34 2.3.1Vertical mattress sutu
6、re according to Donati 34 and McMillen 2.3.2Modified vertical mattress suture according 35 to Allgwer 2.3.3Intracutaneous suture according to Chassaignac36 and Halsted using nonabsorbable suture material 2.3.4Intracutaneous suture according to Chassaignac 37 and Halsted using absorbable suture mater
7、ial 2.3.5Skin closure with DERMABOND39 2.4Ligature of blood vessels4041 4 76 1. KNOTS The knots shown on the following pages are those most commonly used in modern surgery, and the pictures show them from the surgeons angle. The best way to practise tying initially is with a two- coloured string, at
8、 first always holding the coloured end in the right hand. Later practice blind and then with surgical gloves and surgical suture materials in different sizes. That way you can get a feeling of how many throws in opposing directions are needed with each suture material in order to obtain a secure kno
9、t The right index finger grips the white end and pulls it through under the purple end. By turning the right hand inwards and extending the right index finger, the purple end is pushed through the white loop . 98 1.1 Square knots One-hand technique Experience has shown that the square knot is one of
10、 the best and is there- fore generally recommended. Whenever possible, it is tied with both hands in order to achieve with a few throws in “genuinely” opposite directions a knot that does not slip. In certain situations, however, use of only one hand is unavoidable, either only the left or only the
11、right hand. The purple end of the thread is held between the thumb and middle finger of the right hand, while the raised and extended index finger of the right hand acts as a bridge. The white end of the thread is held between the thumb and index finger of the left hand. 1.1 Square knots One-hand te
12、chnique 11 1.1 Square knots One-hand technique 10 . and then pulled completely through the white loop. The first stage of this knot is completed by pulling both ends of the thread vertically. The right hand points towards the surgeon and the left hand away from the surgeon. 1.1 Square knots One-hand
13、 technique The right hand moves its grasp as shown. The purple end of the thread is held between the right thumb and index finger. The right hand grasping the purple end of the thread is turned so that the palm of the hand is showing towards the surgeon. 13 1.1 Square knots One-hand technique 12 The
14、 white end of the thread is placed over the purple end by the left hand. The white end is passed by the right middle finger under the purple end. The purple end is grasped between the right middle and ring finger . and passed under the white end of the thread 1.1 Square knots One-hand technique 15 1
15、.1 Square knots One-hand technique 14 . and pulled through fully. The knot is completed by pulling both ends of the thread vertically. The left hand points towards the surgeon and the right hand away from the surgeon. Square knot, overview of one-hand technique 1.1 Square knots One-hand technique 17
16、16 1.2 Square knots Two-hand technique Simplest and best knot, if circumstances permit. The white end of the thread is placed over the extended index finger of the left hand, which acts as a bridge. The thread is held with the left hand. The purple end of the thread which is held in the right hand, is passed between thumb and index finger of the left hand. Left index finger and thumb move to the left and pass under the white end of the thread. Left index finger and thumb grasp the
