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1) This
shows the beginning of knot
construction.
Note
that the short end is beneath the
tubing, away from the surgeon. |
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2) The
needle holder is held above the tubing
pointing from right to left.
The left
hand has brought the long end
away from the surgeon to begin
to form a loop. |
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3) The long
strand has now been looped around the
needle holder and the tip of the needle
holder is being rotated away from the
surgeon to grasp the tip of the short
end. |
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4)
The needle holder,
which now protrudes through the loop,
grasps the short strand and it will be
pulled back through the loop toward the
surgeon. |
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5) As the
short end is pulled toward the surgeon,
the long end is pushed away. |
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6) The
throw is tightened by pulling with equal
tension in both directions. |
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7)
The left hand
initiates creation of the 2nd loop by
bringing the long strand toward the
surgeon.
Note that the short end is now toward
the surgeon, and the needle holder again
is pointing to the left. |
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8) The left
hand brings the long strand toward the
surgeon across the needle holder to form
a loop. The tip of the needle holder
will now be rotated toward the surgeon
to grasp the short end. |
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9)
The tip of needle
holder has now been rotated toward the
surgeon, and grasps the short end, which
will be pulled back through the loop. |
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10) The
needle holder has now pulled the short
end back through the loop away from the
surgeon and the left hand pulls the
long strand toward the surgeon.. |
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11) The second throw is tightened by
pulling with equal tension in opposite
directions. Additional throws are added,
alternating between the first and second
throws. For braided suture material,
such as silk, 3 throws are generally
sufficient. For monofilament material,
such as nylon or prolene, 5 or 6
alternating throws are required to
prevent knot failure. |
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