SUMMARY OF KNOTTING AND SUTURING

TECHNIQUES

Department of Surgical Research and Techniques

Basic Surgical Practicals

Knotting techniques

Viennese knot Surgical knot

Department of Surgical Research and Techniques

Basic Surgical Practicals

Department of Surgical Research and Techniques

Basic Surgical Practicals

Viennese Knot

Scalpel grips

fiddle-bow holding pencil holding

Department of Surgical Research and Techniques

Basic Surgical Practicals

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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Department of Surgical Research and Techniques

Basic Surgical Practicals

Holding of the forceps

Department of Surgical Research and Techniques

Basic Surgical Practicals

Handling the scissors

The thumb-ring finger

grip !

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Department of Surgical Research and Techniques

Basic Surgical Practicals

Handling theMathieu needle holder

in left hand in right hand

Department of Surgical Research and Techniques

Basic Surgical Practicals

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

Insertion of the thread

Department of Surgical Research and Techniques

Basic Surgical Practicals

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

Department of Surgical Research and Techniques

Basic Surgical Practicals

Department of Surgical Research and Techniques

Basic Surgical Practicals

Department of Surgical Research and Techniques

Basic Surgical Practicals

Knot tied using Instruments

Department of Surgical Research and Techniques

Basic Surgical Practicals

Department of Surgical Research and Techniques

Basic Surgical Practicals

Suture removal

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

• 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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Department of Surgical Research and Techniques

Basic Surgical Practicals

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Department of Surgical Research and Techniques

Basic Surgical Practicals

Department of Surgical Research and Techniques

Basic Surgical Practicals

Suture removal

The thread runs intracutaneously on

one side of the wound

Donati suture Allgöwer suture

Department of Surgical Research and Techniques

Basic Surgical Practicals

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

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

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

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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Suture removal

Department of Surgical Research and Techniques

Basic Surgical Practicals

• 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

Department of Surgical Research and Techniques

Basic Surgical Practicals

• 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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Department of Surgical Research and Techniques

Basic Surgical Practicals

Department of Surgical Research and Techniques

Basic Surgical Practicals

Department of Surgical Research and Techniques

Basic Surgical Practicals

Suture removal