Surgical knots

Surgical knots are knots that are used in surgery . They are often used to tie sutures and ligatures .

history

As early as the 1st century, the Greek doctor Heraklas described sixteen knots for surgical and orthopedic purposes. Seven of these knots are still in medical use and four were recently rediscovered.

Subjects in a 2006 space program study were tasked with tying surgical knots to determine the effects of low gravity on fine motor skills.

Knot

For tying knots in operations surgeons use special techniques, often from Knüpfvarianten the remaining knots differ.

One-handed knot

With the one-hand knot technique, one hand performs the knotting movement while the other hand holds the thread under tension. The resting hand is called the pulling hand; she holds the end of the train. The active hand is called the knotting hand; she holds the knot. The technique, which is easy to learn, requires little space and can therefore be carried out in depth. However, more steps are required to tie a secure knot.

Right-handed people often tie with their left hand so that the dominant hand doesn't have to put the needle holder down.

In order to lay half a beat , the surgeon can use the basic techniques of the middle finger and index finger knot. With the right hand as a knotting hand, he receives a left-handed knot with the middle finger knot and a right-handed knot with the index finger knot. To get a secure knot, you have to knot at least twice in the same direction and once in opposite directions. Half the beat can be tipped into a half knot .

Middle finger knot

The surgeon holds the suture between thumb and forefinger. With a nodding twist of the knotting hand, he puts the knot thread around his middle to little finger. Then the middle finger grabs the pulling thread and pulls it under the knot thread. By stretching the middle finger, he clamps the tying end between the middle and ring finger and pulls it through the resulting eye .

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Index finger knot

The surgeon holds the thread between the thumb and middle finger while the index finger is slightly apart. With a rolling turn of the knotting hand, he places the knotting thread over the pulling thread. The index finger pulls the pulling thread around the knotting thread. While the thumb and ring finger fix the thread, the middle finger grasps around. Then the index and middle fingers pull the thread through the eye.

Two-handed knot

With the two-hand knot technique, both hands perform movements for tying. Although the technique is more difficult, it enables more complex knots with fewer movements. However, there is no tension on the thread during knotting.

With the technique all knots can be tied. For example, the square knot in the one-hand technique is started with a middle finger knot , this is tilted and finished with an index finger knot . The surgeon's knot , on the other hand, is tied as a two-hand knot in which one hand is knot a middle finger and the other is an index finger knot at the same time. The knot is then closed with another one-handed knot.

node

Basic skills include tying the square knot and the surgeon's knot.

In the minimally invasive surgery especially coming slip knot used. These can be placed at the end of the thread and pushed back to the seam. So it is possible to knot them extracorporeally (outside the body). The most important representatives are the Röder , Melzer-Buess, Weston and the newer Von-Leffern knot . Suppliers of medical material also offer these knots prefabricated with knot pushers.

Individual evidence

1. ↑ J. Joris Hage: Heraklas on knots: sixteen surgical nooses and knots from the first century AD In: World Journal of Surgery . No. 32 , April 2008, doi : 10.1007 / s00268-007-9359-x , PMID 18224483 .
2. ↑ Azhar Rafiq et al .: Microgravity Effects on Fine Motor Skills: Tying Surgical Knots During Parabolic Flight . In: Aviation, Space, and Environmental Medicine . Volume 77, No. 8 , August 1, 2006, p. 852-856 , PMID 16909881 .
3. ↑ ^{a b} Sutures and knots. In: anvil. Retrieved March 20, 2020 . 
4. ↑ Knot technology. In: Georg-August-Universität Göttingen. Retrieved March 20, 2020 . 
5. ↑ Middle finger knot - knot course, episode 1 - AMBOSS video on YouTube , accessed on March 20, 2020.
6. ↑ Index finger knot - knot course, episode 2 - AMBOSS video on YouTube , accessed on March 20, 2020.