Product Manual

Knot construction can be accomplished by either an instrument or hand tie. An
instrument tie occurs by the formation of suture loop over an instrument, usually
a needle holder. The right hand holds the needle holder, while the left hand loops
the fixed suture end around the instrument. The position of the instrument in
relation to the suture ends during knot construction will determine the type of
knot. When the instrument is placed above the fixed suture end during the first and
second throws, a square-type knot will develop. In contrast, a granny-type knot will
first result when the instrument is placed above the fixed suture end for the first
throw and then below the fixed suture end for the second throw. By repeating this
positioning, the instrument tie is a reliable and easy method to produce multiple
throw granny knots (1x1x1), a circumstance not encountered in hand ties. Granny
knots with more than two throws cannot be constructed by either the one-hand or
two-hand technique, without releasing hold of both suture ends.
Instrument tying is accomplished primarily by the surgeon’s left hand, which holds
the fixed suture end. Initially the length of the fixed suture end held by the left hand
is long (17 in.), making it difficult to form knots without injuring the attending
assistant. This assault can be avoided by shortening the length of the fixed suture
end held by the left hand. Preferably, the fixed suture end should be coiled into
loops, which are held between the tips of the thumb and index finger.
instrument tie
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