Institute of Surgical Research

Surgical Techniques

A2. Practical Module

Surgical Deontology

Basic surgical instruments;

Textiles in the operating room;

Suture materials;

Tying surgical knots;

Asepsis and the patient: preparing the operative site

Holding scissors

Holding scalpels

„fiddle bow” „pen”

Holding forceps

„pen” „knife”

Holding locking instruments

Holding hemostatic forceps

Holding needle holders

Hegar Mathieu Holding a Hegar-type needle holder

Basic surgical knots

Half hitch Square knot Sailor’s knot Surgeon’s knot

Tying surgical knots 1.

The ends of sutures and ligatures are joinedwith surgical knots. Requirements:

- quick- strong- safe

Incorrect knots can lead to severe postoperative complications !

Loose knot = haemorrhage, thicker scarFully tightened knot = blocks local blood

supply, slow wound healing

Tying surgical knots 2.

A half hitch = the threads form a closed loop.

Two identical half hitches tied above one another = granny knotbutthis slips easily, therefore it must not be used in surgery !

Tying surgical knots 3.

In surgical practice a knot consists of at least two mirror image half hitches, one placed on the other:

base half hitch + second half hitch (in the opposite direction).

Before tying a half hitch the threads should be crossed!

The number of half hitches depends on the types of threads (synthetic threads require extra ones - up to 6 or more).

Tying surgical knots 4. Methods of tying knots in surgery:

- two-handed knot: both hands take an active part in the formation of the knot

- one-handed knot: one hand is active, the other holds the thread,

then the knot is tied with both hands

- instrument tie: with needle holders, mosquitos (1. in a deep

cavity; 2. with atraumatic needles; 3. with short suture materials

Tying surgical knots 5.

Methods of tying two hand knots:

- two-handed square knot- surgeon’s knot- Viennese knot- instrument tie

Methods of tying one-handed knot and instrument tie will be taught by the Suture Tutor program.

Tying knots: Two-handed square knot

Tying knots: Surgeon’s knot

Tying knots: ‘Viennese’ knot

Tying knots: Instrument tie

4. Repeated disinfection with iodine tincture on a smaller area

3. Disinfection with iodine tincture (from the central area to the periphery)

Preparing the operative site 1.(cleansing)

1. Cleansing with benzine (from the central area to the periphery)

2. Repeated cleansing with benzine

IT IS FORBIDDEN:to return to a cleansed areawith the same sponge!

Preparing the operative site 1. Instruments for skin cleansing

Skin cleansingPreparing the operative site 2.

DrapingPreparing the operative site 3.