SUMMARY OF KNOTTING AND SUTURING TECHNIQUES
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SUMMARY OF KNOTTING AND SUTURING
TECHNIQUES
Department of Surgical Research and Techniques
Basic Surgical Practicals
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Knotting techniques
Viennese knot Surgical knot
Department of Surgical Research and Techniques
Basic Surgical Practicals
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Department of Surgical Research and Techniques
Basic Surgical Practicals
Viennese Knot
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Scalpel grips
fiddle-bow holding pencil holding
Department of Surgical Research and Techniques
Basic Surgical Practicals
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Straight, long incision
Use your hand to fix the skin Fiddle-bow holding!
Use the belly of the blade Cut epidermis and dermis through sharply
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Basic Surgical Practicals
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Holding of the forceps
Department of Surgical Research and Techniques
Basic Surgical Practicals
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Handling the scissors
The thumb-ring finger
grip !
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Basic Surgical Practicals
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Handling theMathieu needle holder
in left hand in right hand
Department of Surgical Research and Techniques
Basic Surgical Practicals
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The proper position of the needle in the needle holder
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eye of the needle
tip of the needle
Department of Surgical Research and Techniques
Basic Surgical Practicals
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Insertion of the thread
Department of Surgical Research and Techniques
Basic Surgical Practicals
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Simple interrupted suture
• 1 cm rule!• the knot is on the side• slow• safe• skin• fascia• muscle
Department of Surgical Research and Techniques
Basic Surgical Practicals
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Department of Surgical Research and Techniques
Basic Surgical Practicals
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Department of Surgical Research and Techniques
Basic Surgical Practicals
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Department of Surgical Research and Techniques
Basic Surgical Practicals
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Knot tied using Instruments
Department of Surgical Research and Techniques
Basic Surgical Practicals
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Department of Surgical Research and Techniques
Basic Surgical Practicals
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Suture removal
Department of Surgical Research and Techniques
Basic Surgical Practicals
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Basic Surgical Practicals
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Basic Surgical Practicals
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• wide-wide-close-close• four punctures in the same
vertical line• 1,5 cm and 1-2 mm• in the subcutaneous layer and
superficial • knot on the side• skin• slow• wide and deep and superficial
wound closure
Vertical mattress suture (Donati)
Department of Surgical Research and Techniques
Basic Surgical Practicals
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Basic Surgical Practicals
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Basic Surgical Practicals
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Department of Surgical Research and Techniques
Basic Surgical Practicals
Suture removal
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The thread runs intracutaneously on
one side of the wound
Donati suture Allgöwer suture
Department of Surgical Research and Techniques
Basic Surgical Practicals
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Horizontal mattress suture line• 1 cm from the wound edge• 1 cm parallel to the wound
edge, a double suture• deep in the subcutaneous
layer
• skin
• in case of higher wound tension
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Basic Surgical Practicals
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Basic Surgical Practicals
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Basic Surgical Practicals
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Running suture line• knot should be tied
only at the beginning and the end
• fast• the tension is distributed
equally along the length of the suture – edema
• not so safe• peritoneum• vessels• skin• GI tract
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Basic Surgical Practicals
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Basic Surgical Practicals
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Basic Surgical Practicals
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Suture removal
Department of Surgical Research and Techniques
Basic Surgical Practicals
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• knot should be tied only at the beginning and the end
• last knot – 3 tails• reduces the skin tension• results in more tissue
eversion• skin
Department of Surgical Research and Techniques
Basic Surgical Practicals
Running-lock closure
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Department of Surgical Research and Techniques
Basic Surgical Practicals
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• stitches run in the subcuticular plane
• fast• cosmetically/aesthetically
fine scar • knot should be tied
only at the beginning and the end
• skin• it is used in the skin with
minimal wound tension
Department of Surgical Research and Techniques
Basic Surgical Practicals
Running intracuticular closure
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Basic Surgical Practicals
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Department of Surgical Research and Techniques
Basic Surgical Practicals
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Department of Surgical Research and Techniques
Basic Surgical Practicals
Suture removal