Product Manual

The surgeon may use an individual ligature (“free tie”) or a suture that is attached
to a needle or ligature reel. The length of a free tie or suture attached to a needle is
usually 18 inches. The longest strands of suture material are available on a reel or
spool. When the suture is attached to a needle or reel, there is a free end and a fixed
end; the fixed end is attached to either the needle or reel. The first throw of a knot
is accomplished by wrapping the free end either once or twice (surgeon’s) around
the fixed end. During practice, clamp one end of the suture with an instrument that
serves to represent either the needle or the reel, which is the fixed end of the suture.
Formation of each throw of a knot is accomplished in three steps. The first step
is the formation of a suture loop. In the second step, the free suture end is passed
through the suture loop to create a throw. The final step is to advance the throw
to the wound surface. For the first throw of a square, granny, and surgeon’s knot
square, for each additional throw the direction in which tension is applied to the
suture ends is reversed. The surgeon should construct a knot by carefully snugging
each throw tightly against another. The rate of applying tension to each throw
should be relatively slow.
For either the square knot or surgeon’s knot square, the direction in which the
free suture end is passed through the loop will be reversed for each additional
throw. If the free suture end is passed down through the first suture loop, it must
be passed up through the next suture loop. Reversal of the direction of passage of
the free suture end through the loops does not alter either the knot’s mechanical
performance or its configuration. It simply reverses the presentation of the knot
(Figure 8). For granny knots, the direction in which the free suture end is passed
through the loop is the same for each additional throw.
VI. tying techniques
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