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Surgical Knots

Surgical Knots

Choose a knot below, or scroll down for more information:  
Constrictor Knot -Forceps Around Method - Surgical Knots

Surgical ligature used to secure duct or blood vessel.

Constrictor Knot - Forceps Slide Method - Surgical Knots

Surgical ligature tied at the end of duct or blood vessel.

Constrictor Knot - Instrument Method - Howard Technique

Surgical constrictor using the Howard technique.

Constrictor Knot - Retrieve End Method - Surgical Knots

Surgical Constrictor using clamp to retrieve suture end.

Ligature Knot- - Instrument Technique - Surgical

Surgical Double-Throw knot tied using an instrument

Ligature Knot - One-Handed Technique - Surgical Knot

Surgical Double-Throw knot tied using one hand.

Ligature Knot - Two Handed Technique - Surgical Knot

Surgical Double-Throw knot tied using two hands.

Surgical Slip Tie Knot - Surgical Knot

Allows knot to be slid down into the wound and then tightened.

Surgical Tie Knot - Instrument Technique - Surgical Knot

Shows a simple Square Knot being tied with forceps.

Surgical Tie - One Handed Technique - Surgical Knot

Standard One-Handed knot used by surgeons.

Surgical Tie - Two Handed Technique - Surgical Knot

Standard Two-Handed knot used by surgeons.

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Welcome to Surgical Knots

We introduced this section partly to accompany our research on surgical knots showing that the Constrictor is markedly superior to knots usually employed by surgeons1. The paper has generated interest and, as a result, the Royal College of Surgeons has kindly made it available online.

Animations

We show four techniques for tying the Constrictor in Surgery as well as animations for Surgical Ties and Ligatures – all tied from the surgeon's viewpoint. Each animation can be flipped to suit right-handed and left-handed operators or inverted to help an instructor guide a student sitting across a table.

Names

Surgical Ties are commonly described as "One-Handed" or "Two-Handed" – slightly confusing because both techniques involve two hands. We have added the names "Push" and "Pull" based on the way that the end is guided through each knot.

Surgical Knots

Constrictor: First Use in Surgery and Research

A completed surgical knot is sometimes out of sight. Worse, common techniques may create an unreliable stack of Half Hitches instead of the intended Square (Reef) knot. This partly explains the custom of adding multiple extra Half Knots. The Constrictor eliminates this risk. Its first use in Surgery may be attributed to my brother James who used it for years as a General Surgeon to tie off small skin lesions at their base. However, Howard Taylor deserves the credit for its first use as a surgical ligature - to tie off major blood vessels, etc., He used it for years in his veterinary practice before he and I validated its superiority over traditional ligatures:

Reference

1 Taylor H, Grogono AW. The constrictor knot is the best ligature. Ann R Coll Surg Engl. 2014 (96): 101-105.

Which Knot Should I Use?

Surgical Ties (Single Throw)
One Handed (Pulling Technique)
Two Handed (Pushing Technique)
Instrument Technique

Ligature Ties (Double Throw)
One Handed (Pulling Technique)
Two Handed (Pushing Technique)
Instrument Technique

Constrictor Ligature Options
Instrument Tie (Howard Technique)
Tie around forceps
Retrieve end with forceps
Slide knot down forceps

Surgical Slip Ties
Slide Half Hitches down

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