Core Surgical Skills ...

Course Overview

Download the Course Syllabus

This 0.25 credit (4.0-contact hour) course is intended to provide the novice surgeon with detailed instructions on the how to effectively construct commonly used knots in soft tissue surgery.

Prerequisites

The Basic Instrument Use course is a recommended prerequisite for enrolling in this course. The course is designed to support the following academic uses:

• 1st year veterinary students as an aid to learning proper knot-tying techniques
• 2nd and 3rd year veterinary students to support junior surgery courses and laboratories
• 4th year veterinary students as a refresher during clinical rotations

Learning Objectives for the Course

Upon completing this course, students will be able to:

• Define the major components of knot tying (e.g., loop, throw, knot, fixed strand, intrinsic suture tension)
• Choose the appropriate number of throws for interrupted stitches for monofilament and multifilament sutures
• Adopt a consistent set-up for knot tying
• Create a square knot using the instrument technique, one- and two-hand tie techniques, and in a deep plane with the two-hand technique
• State the advantages and disadvantages of instrument ties versus hand ties

Organization

This course is presented in five modules. The first module introduces the course and its creators. The next four modules are composed of a series of topics, each focusing on various aspects related to knot tying.

For optimal learning, it is recommended that students follow the suggested learning path laid out in the course menus. However, students can access any section of the course at any time. To facilitate long-term retention of the course materials, students are encouraged to pace themselves as they work through the course materials, allowing sufficient time to integrate and apply the information within each module before moving on.

Module 2: Introduction to Knot Tying

Module Objectives

1. Define the terms suture loop, throw, knot, and knot ear.
2. Explain what the fixed and unfixed strand means with regard to tying surgical knots. Explain why it is important to place the strands in the proper position before you begin knot tying.
3. Be able to identify a square knot, a granny knot, and a reverse double half hitch knot. Explain the mechanics of how each of these knots is formed.
4. Explain the concept of intrinsic suture tension, and describe an instance when high intrinsic tension is necessary in a surgical procedure and a situation when it is contraindicated.
5. Describe each of the three distinct steps required to create a basic surgical knot.
6. Explain the eight important basic knot-tying rules to help create consistently secure knots.
7. Know the major factors related to knot security. Understand the difference in the mechanism of knot security between multifilament and monofilament suture materials.
8. State the advantages and disadvantages of using monofilament and multifilament suture materials in knot tying.
9. Choose the appropriate number of throws for interrupted stitches for monofilament, multifilament, and suture wire, as well as for knots at the beginning and end of a continuous suture line.

Module 3: Getting Started

Module Objectives

1. Know common terms related to hand and wrist movements and positioning so that you will be able to follow detailed instructions for knot tying later in this module.
2. Know why you must practice uncoupling your thumb and index finger from your middle, ring, and little fingers during hand tying.
3. Know why it is so important that the surgeon "set up" for suture knotting correctly and consistently, and why maintaining the same perspective when tying structures with varying orientations helps reduce improper knot formation and operator confusion.

Module 4: Practical Knot-Tying Techniques

Module Objectives

1. Be able to adjust the suture strands by gathering and sliding with your left and right hands to achieve an appropriate working distance for knot tying.
2. Create a square knot using the instrument technique.
3. Create a surgeon's knot using the instrument technique.
4. Know the steps that should be taken to avoid creating a granny knot and slip knot, and know how to identify these knots when they are accidentally created.
5. Be able to construct a square knot with a one- and two-hand tie technique.
6. Be able to complete a square knot in a deep plane with a two-hand technique.

Module 5: Clinical Considerations for Knot Tying

Module Objectives

1. State the advantages and disadvantages of instrument ties versus hand ties, and list some common surgical applications for each.
2. Know which hand ties are best suited to different surgical scenarios.
3. Explain the indications and contraindications for the surgeon's knot.
4. Explain how monofilament and multifilament suture handles differently with respect to knot slippage when tying a square knot.

Methods

This course utilizes a variety of multimedia instructional methods such as narrated video flipbooks, illustrations, interactive practice exercises, hands-on independent activities, and an optional supervised laboratory guide. Students are responsible for all of the material presented within the course, regardless of the format in which the material is presented.

Grading

You can view a summary of your course grade at any time by clicking the Grades link, located under the Course Administration section of the Settings block. The block may be docked in the top, left corner of your screen.

Supplemental Texts

There are no required textbooks for this course. However, for additional information on the subjects covered within this course, please refer to the following list of suggested resources:

Anderson RM, Romfh RF: Technique in the Use of Surgical Tools. Appleton-Century-Crofts, New York, 1980.

Knecht CD, Allen AR, Williams DJ, Johnson JH: Fundamentals in Veterinary Surgery. 3rd ed. WB Saunders, Philadelphia, 1987.

Nealon TF: Fundamental Skills in Surgery 2nd ed. WB Saunders, Philadelphia, 1971.

Toombs JP, Clarke KM: Basic Operative Techniques. In Slatter editor, 3rd ed. Textbook of Small Animal Surgery, 199-222, 2002.

Copyright

All content in the Knot Tying course, including videos, images, text, graphics, and audio, is the property of Texas A&M University, Colorado State University, and The Ohio State University. Redistribution or commercial use without the expressed, written permission of these institutions is prohibited. For information on usage rights, contact The Center for Educational Technologies at Texas A&M University, College of Veterinary Medicine & Biomedical Sciences, 979-862-2027.