What are the recommendations for tying a one-handed surgical knot?

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From the Research

To tie a one-handed surgical knot effectively, it is essential to prioritize the security and integrity of the knot, especially when using monofilament sutures, which are more prone to loosening than braided materials, as noted in studies such as 1. When deciding on the technique for tying a one-handed surgical knot, several factors must be considered, including the type of suture material, the specific surgical procedure, and the surgeon's preference and skill level.

  • The choice between monofilament and braided sutures can significantly impact knot security, with monofilament sutures like polypropylene offering high tensile strength but being more susceptible to knot slippage, as discussed in 2 and 1.
  • The technique itself involves holding the suture in the dominant hand and creating a loop around the needle holder, then grasping the short end of the suture and pulling both ends in opposite directions to tighten the knot, similar to the method described in 3.
  • For added security, alternating between throwing loops clockwise and counterclockwise to create square knots rather than slip knots is recommended, as this enhances knot stability and reduces the risk of knot failure, a principle supported by the findings in 4.
  • Maintaining tension throughout the process and ensuring the knot is tight enough to secure tissue without damaging the suture material or compromising tissue viability are critical, as emphasized in the context of optimizing arthroscopic knots using braided or monofilament suture 4.
  • Given the potential for suture damage, especially with monofilament materials like polypropylene, as highlighted in 2, careful handling and avoidance of excessive tension or deformation during knot tying are crucial.
  • Ultimately, the goal is to achieve a secure knot that minimizes the risk of failure while preserving tissue integrity, which can be facilitated by selecting appropriate suture materials and mastering the one-handed knot-tying technique, as informed by studies such as 5.

References

Research

Comparative study of knot performance and ease of manipulation of monofilament and braided sutures for arthroscopic applications.

Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2004

Research

Clamp fixation to prevent unfolding of a suture knot decreases tensile strength of polypropylene sutures.

Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2012

Research

Optimizing arthroscopic knots using braided or monofilament suture.

Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 1998

Research

An evaluation of suture materials used in tendon surgery.

Journal of hand surgery (Edinburgh, Scotland), 1989

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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