Professional Documents
Culture Documents
Knot and Suture T
Knot and Suture T
62
A knot-tying
primer
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,
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 and 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 publication.
We hope that our information brochure is of use to you and
wish you every success in your professional practice.
Norderstedt, April 2003
Contents
Knots
1.1
1.2
1.3
Suture techniques
29
2.1
2.1.1
2.1.2
Subcutaneous sutures
Subcutaneous suture using interrupted sutures
Subcutaneous suture using a continuous suture
30
31
31
2.2
2.2.1
2.2.2
32
32
33
2.3.
2.3.1
34
34
2.3.5
Skin sutures
Vertical mattress suture according to Donati
and McMillen
Modified vertical mattress suture according
to Allgwer
Intracutaneous suture according to Chassaignac
and Halsted using nonabsorbable suture material
Intracutaneous suture according to Chassaignac
and Halsted using absorbable suture material
Skin closure with DERMABOND
2.4
2.3.2
2.3.3
2.3.4
7
815
1623
2427
35
36
37
39
4041
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 twocoloured string, at 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 knot
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.
8
10
11
12
13
14
15
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.
16
17
18
19
20
21
... and the knot is completed by pulling both ends of the thread vertically.
The left hand points away from the surgeon and the right hand towards the
surgeon.
22
23
The short purple end of the thread is free, while the long white end is held
between index finger and thumb of the left hand. The first two loops are
made by placing the thread around the needle holder.
24
25
26
27
2. SUTURE
TECHNIQUES
The most important suture techniques for closing
subcutaneous tissue and skin are described below.
28
29
2.1.1
30
The sutures are placed through the subcutaneous tissue as shown and
then tied.
32
33
34
The Allgwer mattress suture differs from the Donati and McMillen mattress
suture only in the fact that the thread does not penetrate the surface of the
skin on the contralateral side.
35
36
37
DERMABOND
38
39
Correct placement of a
ligature of a vessel branch.
Wrong!
40
Wrong!
41
Notes:
Notes: