Knot tying question

[Wardens]

I'm in my intern ENT year and started the year on neurosurgery. My chief resident taught me to tie fascia/galea and muscle by one-handed tying using my left hand to apply tension. The first two knots are thrown with my right hand in the same direction, with the second throw applying the most tension and the third knot 'locking' by using the reverse throw. In practicing, I have come to learn that this is a 'slip knot' that's locked with the third throw.

I also have developed a feeling that my attendings/chiefs on general surgery will have a conniption if I throw this way in their OR. I like the way I was taught and feel comfortable with it, but anticipate having to learn something else. Is this approach ever used in general surgery? Thanks.

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[ESU_MD]

very common in vascular procedures. as far as gen surg, isnt everything stapled nowadays? actually, no matter what technique you use, an attending will always critique you and convince you that their way is better.

for instance- i think you have the right idea tying one handed, but tie with your left, that way you dont have to set down/switch your needle driver. it is much more efficient

 

[Winged Scapula]

It depends highly on the program.

In ours, many attendings would not allow interns to tie one-handed. It does come in handy in tight spaces like vascular. Most programs want their junior residents to learn to tie, because many do prefer ties over staples and well, its tradition.

I personally prefer the two handed tie because I think its more secure, but that's just me. As ESU notes, no matter what you do, someone will probably correct you, but it may be worth asking the GS residents what's expected for interns, although as an off-service/Prelim, I suspect the GS attendings won't care much what you do.

 

[IOE]

no matter what technique you use, an attending will always critique you and convince you that their way is better.

Very true! I used to get yelled at for tying one-handed ties as an intern, now i get yelled at for using the two-handed technique as a 3rd yr...its pretty confusing/hard trying to please all the attendings at once.

Being able to tie with both hands is crucial though, it comes in handy at those difficult corners and definately in vascular cases. Just practice practice practice..g'luck

 

[kocker]

I was on an away and everyone seemed to be throwing a surgeon's knot first.... no one at my home program does that.... i'm loving it though.