One Handed KnotTying a One Handed Surgeon Knot
Things to Keep In Mind
A close friend from Connecticut training was showing to be a doctor showed me this amazing knot he was learing called, A One Handed Surgeon’s Knot. The surgeon’s knot, which is looping the suture twice in the same direction before locking it, is generally used when tying under tension as it prevents slippage. You generally want to use the least amount of suture necessary for a secure knot.
The description of this knot is a bit decieving as you need Two Hands to do it.
I thought it was pretty interesting so I’m sharing it here on Random Topics. Afterall what could be more random than learning How to Tie a One Handed Surgeon Knot.
Boston University School of Medicine and Surgery
One Hand Tie – One Hand Square Knot
Wayne W. LaMorte, M.D., Ph.D., M.P.H.
Photography by Michael J. LaMorte
Two hand ties are generally preferred by most surgeons, but one hand ties can also be used.
First Step in tying a One Handed Knot
1) Note that the short end has been placed beneath the tubing and is held in the right hand, away from the surgeon. The long strand is held in the left hand.
Second Step in tying a One Handed Knot
2) The right index finger initiates formation of the first loop by pushing the short strand to the left and above the long strand. The left hand begins to move the long strand to the right.
Third Step in tying a One Handed Knot
3) The right index finger is shown inserted into the loop that has been created. Clearly you have to use Two Hands to Tie a One Handed Knot.
Fourth Step in tying a One Handed Knot
4) The right index finger now begins to roll behind the short strand, which is still being grasped by the thumb and middle finger.
Fifth Step in tying a One Handed Knot
5) The end of the short strand has now been released by the right thumb, and the index finger is being used as a lever to rotate the short end up through the loop.
Sixth Step in tying a One Handed Knot
6) As the short end emerges from the loop, the middle finger pinches it against the forfinger to re-grasp it.
Step Seven in tying a One Handed Knot
7) And the throw is tightened by pushing the long strand away… and pulling the short strand toward the surgeon with equal tension. Note that tension is applied by pulling the two strands in opposite directions at an angle of 180 degrees.
Step Eight in tying a One Handed Knot
8) As the second throw is initiated, the short end is toward the surgeon and is being grasped by the thumb and index finger.
Step Nine in tying a One Handed Knot
9) The right index finger and thumb continue to grasp the short end, as the middle and ring fingers are placed behind the short end to begin creating a loop. The left hand has begun to bring the long strand toward the surgeon.
10) The right hand has supinated slightly …
11) … as the left hand brings the long strand toward the surgeon and across the short strand to form a loop.
12) The right middle finger has now been flexed so it can slide behind the short strand.
13) The right middle finger is now behind the short strand, which is still being grasped by the thumb and index finger.
14) The right middle finger is now used as a lever to rotate the short end away from the surgeon.
15) The short ended is released by the thumb, but the ring finger pinches the short end inside the loop by squeezing it against the middle finger.
As you can see here, tying a One Handed Sugeons Knot is an involved process. If you are interested learning more about this topic visit the link below. – John Denner
Square vs Slipknot
Square vs Slipknot
Square knot refers to tying in opposite directions to lock a knot. It also refers to laying down a throw squarely. You can see a demonstration of these concepts in the videos linked above.
Slipknot is when you throw two throws in the same direction. This allows you to secure it without locking, helping you prevent air knots.
Efficiency is the name of the game in the operating room. All your movements should be deliberate and intentional. A mistake I often see is tying a one-handed knot while moving your post (stationary hand). This defeats the purpose of a one handed knot.
Once you get the hang of tying, focus on details like eliminating unnecessary movements and not tugging too hard. If you’re tying over a delicate vessel, you need to be able to tie a knot securely without damaging vital structures.
Practice! I would have ties on my water bottle or notebook and tie while watching TV or listening to lectures. Do what works best for you. Practice with both hands. Being able to tie one- and two-handed with either your left or right hand will serve you well in the OR.
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