Product Manual

This maneuver is accomplished by first grasping the fixed suture end with the

small and ring fingers, while it is being pinched between the tips of the index

finger and thumb. By pronating the wrist, a loop forms around the grasped

fingers, and the top of the loop must again be grasped between the tips of the

thumb and index fingers. The small and ring fingers are then withdrawn from

the loop before coiling more suture. The rasped suture can be easily lengthened

by releasing the coils held between the tips of the thumb and index finger.

When tying knots with an instrument, it is difficult to apply continuous

tension to the suture ends. Consequently, widening of the suture loop due to

slippage is frequently encountered in wounds subjected to strong tension. This

technique, however, is ideally suited for closing a wound which is subjected to

weak tensions. In this circumstance, instrument ties can be accomplished more

rapidly and accurately than hand ties, while conserving considerably more

suture. By using this technique, the parsimonious surgeon can complete 10

interrupted suture loops from one suture measuring 18 inches in length. This

feat would be impossible if the knots had been tied by hand.

The value of instrument ties has become readily apparent in special situations

in which hand ties are impractical or impossible. In microsurgical procedures,

an instrument tie provides the most reliable and easiest method of knot

construction. When employing suture in the recesses of the body (e.g. mouth,

vagina, etc.) or during endoscopic surgery, instruments can also form knots in

sites to which the hand could never gain access.

instrument tie

(cont’d)