Surgical knots

1.

SURGICAL KNOTS

2.

Surgical treatment (treatment using the surgical method of treatment) - a method
of treating diseases by disconnecting and connecting tissues during a surgical
operation.
TISSUES CONNECTION
Bloodless methods
- with a metal staples
- with a patch
- with a surgical glue
Bloody methods
- continuous suture
- separate suture

3.

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5.

6.

SURGICAL SUTURE – CONNECTION OF THE
WOUND EDGES WITH A SUTURE MATERIAL
External sutures
- a skin
- A mucous membranes
Internal sutures
- During a surgical
treatment

7.

SUTURES CAN BE:
Continuous
Separate

8.

LIGATURE
Ligature is a thread applied o a blood vessel or ANY
OTHER hollow organ to narrow its internal space.

9.

10.

THE MOST IMPORTANT THING
IS NOT MEMORIZING
OF NUMEROUS KNOTS AND ITS STRUCTURE,
BUT UNDERSTANDING
THE MAIN PRINCIPLES OF ITS FORMATION!

11.

assistant
External thread
A far half of the
operating field
A wound
A near half of the
operating field
Internal thread
operator

12.

THE MAIN PARTS OF A
SEPARATE SUTURE STITCH
3
2
1. A STICH RING
2. KNOT
3. ENDS OF THE
THREADS
1

13.

Second semi-knot
Every surgical knot consist of AT
LEAST TWO loops
A single weave of threads is called
a SEMI-KNOT
A LOOP – stitch ring completed by a
semi-knot
First semi-knot
Second loop
First loop

14.

CLASSIFICATION
OF LOOPS

15.

1 . BY AMOUNT OF INTERWEAVING IN
THE LOOP
Single
Double
Triple

16.

Be careful!

17.

2. BY SPATIAL STRUCTURE
RIGHT
LOOP
LEFT
LOOP

18.

3. BY TIGHTENING DIRECTION
Symmetric loop is possible only when your thread come out
of an interweaving from other side (far thread become a near
one and the near thread become a far one).
Symmetric
(the good one)
Asymmetric
(The bad one)

19.

KNOTS
CLASSIFICATION

20.

1. BY AMOUNT OF LOOPS
• Amount of loops starts from TWO and more;
• After 3th-4th loop knot strength almost doesn’t increase.
«Sea»
knot
Double
«Sea»
knot
Triple
«Sea»
knot
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21.

2. BY AMOUNT OF INTERWEAVING IN LOOPS
1) Simple – a knots consist of loops only with single interweaving;
2) Complex – we can meet a loop with double interweaving;
a) Equal – amount of interweaving is similar to every loop– “academic” knot;
b) Unequal – amount of interweavings in loops is not similar – “a surgical”
knot.
An “academic”
knot
A “surgical” knot
A “sea” knot.
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22.

3. BY AMOUNT OF STITCH RINGS
I. One-ring knots;
II. Two-ring knots – A Barkov knot;
III. Three-ring knots.
A Barkov knot
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23.

4. BY SPATIAL STRUCTURE OF THE LOOPS
I. Parallel – the loops are alternating (right-left-right-left)
II. Crossed – all the loops are right or left.
III.Mixed – loops can both alternate and match (right-left-left)
A “sea” knot
A “woman” knot.
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24.

5. BY TIGHTENING DIRECTION
I. Symmetric – all the loops are tightened in right direction;
II. Asymmetric – there a loops tightened not right.
1) Sliding – ALL the loops are tightened not right:
A. Simple sliding;
B. Sliding blocked – a «Parisian» knot.
2) Turned – good loops at start, bad loops at the end;
3) Offset – bad loops at start, but good loops at the end.
A «Parisian» knot
Sliding knot
Turned knot
Offset loop
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25.

EXAM
1. Theoretic part
An examination, during which the examinee must answer theoretical
questions, as well as form the knots given by the examiner, to test
the understanding of the principles of knot formation.
The answering process shouldn’t exceed 10 minutes.
2. Practical part
You must braid 30 mm of a “tale” consist of simple knots
for 30 seconds.
Type of thread – caprone, size 2/0.
In case of “window” existing (like on the photo), the
measuring is carried from beginning to this window.
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26.

THANKS FOR YOUR ATTENTION!
Жить на белом свете - значит
постоянно бороться и постоянно
побеждать. - Николай Пирогов
Living this life means a constant
struggling and constant winning.
- Nikolay Pirogov