BEGIN

In this topic, you will learn how to perform basic instrument ties, including the square knot and the surgeon’s knot. The square knot is the simplest and most secure knot available to surgeons; hence, it is the most common knot used in operating rooms. You will also learn about the granny and double half-hitch knots, including how to recognize when these insecure knots have occurred and the steps you should take to avoid them. Often it is the surgeon’s preference which hand tie is chosen in surgery.

SQUARE KNOT

Click or tap the images below to learn more and view demonstrations.

SURGEON'S KNOT

GRANNY KNOT

SLIP KNOT

In this topic, you will learn how to perform basic instrument ties, including the square knot and the surgeon’s knot. The square knot is the simplest and most secure knot available to surgeons; hence, it is the most common knot used in operating rooms. You will also learn about the granny and double half-hitch knots, including how to recognize when these insecure knots have occurred and the steps you should take to avoid them. Often it is the surgeon’s preference which hand tie is chosen in surgery.

Tap the images below to learn more and view demonstrations:

VIEW A DEMONSTRATION

Once you become proficient tying knots on the suture board with thick rope, start to practice with thinner material, like string or suture. As you begin to work with suture material, practice reducing the length of your fixed and free strands. In surgery, the free strand is typically no longer than 3–5 cm during typical instrument knot tying. This allows the surgeon to create more stitches from a suture strand, saving suture material and money. Shorter strands also require less hand and instrument movement, making the knot tying more efficient. However, keep in mind that shorter strands make it more difficult to tie knots without lifting the knot upward, which increases the risk of creating a less secure half hitch.

Granny knots are insecure knots that can lead to surgical complications. It is important for novice surgeons to understand how granny knots are formed so that these knots can be avoided. When practicing knot tying, look carefully at the formed knot to identify when it has been incorrectly performed, and carefully examine your technique to understand why a granny knot developed. 

Granny knots are insecure knots that can lead to surgical complications. It is important for novice surgeons to understand how granny knots are formed so that these knots can be avoided. When practicing knot tying, look carefully at the formed knot to identify when it has been incorrectly performed, and carefully examine your technique to understand why a granny knot developed. Watch this video to learn more. 

Slip knots are insecure knots that can lead to surgical complications. It is important for novice surgeons to be able to recognize slip knots and to understand how they are formed so they can take measures to avoid creating them.

Slip knots are insecure knots that can lead to surgical complications. It is important for novice surgeons to be able to recognize slip knots and to understand how they are formed so they can take measures to avoid creating them. Watch this video to learn more.

The surgeon’s knot is similar to the instrument square-knot technique. The main difference is that, on the first throw, the long, fixed strand is looped around the needle holder not once, but twice. The surgeon’s knot is sometimes used when suturing tissue that is under tension. However, the surgeon’s knot also has important limitations, and it should not be used as a routine method of suturing or ligating tissue. Indications and precautions for the surgeon’s knot will be covered in more detail later in this course.