Product Manual

each additional throw. Most of the knot tying techniques in this manual comply with these
recommendations. However, it is important to point out that the fixed end of the suture
is being passed through the suture loops in the two-hand ties. Consequently, the surgeon
must detach the needle from the fixed suture end before a two-hand tie.
A standard format for illustrating surgical knot tying techniques has been used throughout
the manual (Figure 9). A horizontal incision is pictured in the top of each illustration.
Because the wound edges are subjected to static tensions, there is retraction of the wound
edges, with exposure of the underlying tissue. The surgeon is standing facing the wound
from the bottom of each illustration. Because the surgeon usually passes the needle swaged
to a suture toward himself (herself), the fixed end (black) of the suture with its attached
needle enters the farther side of the mid-portion of the wound and exits from the side of
the wound closer to the surgeon. The free end of the suture is white to facilitate illustration
of the knot tying technique. The suture end (white) farther from the surgeon is grasped
between the tips of the distal phalanges of the left thumb and index finger (tip-to-tip
pinch). The tips of the distal phalanges of the thumb and index finger of the right hand
grasp the suture end (black) exiting from the wound edge closer to the surgeon. The
grasped fingers apply constant tension to the suture ends. The security of this tip-to-tip
pinch can be enhanced by grasping the suture ends between the tips of the long fingers,
ring fingers, small fingers, and the palm of each hand (grip activity).
The tying of square, slip, and surgeon’s knots using manual and instrument-tying
techniques are illustrated in Sections VIII-X. The technique of tying slip knots has been
included in the manual because it is an excellent method to approximate temporarily the
edges of wounds subjected to strong tensions In fact, a slip knot has greater holding power
than either a single-wrap or double-wrap throw.
22
Once there is meticulous approximation
of wound edges, the slip knot can be converted to a square knot, after which a sufficient
number of throws are added to the knot to ensure knot security.
43