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Basic Surgical Technique, Knots and Sutures

Instrument tie

Christoffer Bing Madsen med. student and Magnus Balslev Avnstorp MD.

Most surgical knots in skin/tissue reconstruction are conducted by making an instrument tie.

  1. Grasp the leading/long end of the suture between thumb and index finger and drag to make the short end as short as possible
  2. Place the needle driver between leading and short/trailing end of the suture
  3. Wind the long end twice around the needle holder
  4. Grasp the short end of the suture
  5. Pull the strands in opposite directions perpendicular to the wound edge, with arms crossed
  6. Release trailing end by the needle driver
  7. For the second throw wind the needle driver once around the leading strand and grasp the short end while moving hands in opposite directions
  8. Perform af third and fourth knot
  9. Place the knot on the one side of the wound edge
  10. Cut the ends 5 mm long
  11. Do the 7th step once more, and you are done.
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