Tying Sutures and Ligatures

Tying Sutures and Ligaturespdf format, Adobe Acrobat Required (for printing)
Tying Simple, Interrupted Suturespdf format, Adobe Acrobat Required (for printing)

The general principles of knot tying apply to all suture materials. The completed knot should be small and the ends cut short to minimize foreign body reaction. The smallest suture material of adequate strength should be used, because knots tied with smaller-sized materials are more secure.

Gentleness is extremely important in tying to prevent suture fracture and tissue damage. Excessive tension should be avoided.

Video of Tying Simple, Interrupted Sutures

Instrument Square Knot
Step 1 of Instrument Square Knot Step 2 of Instrument Square Knot Step 3 of Instrument Square Knot Step 4 of Instrument Square Knot
Step 1:
The needle holder is placed between the left and right strands and a loop is formed with the left strand		 Step 2:
The right (short) end is grasped in the needle holder		 Step 3:
The left and right hands are reversed in position and even tension applied.		 Step 4:
The knot is tightened.
Step 5 of Instrument Square Knot Step 6 of Instrument Square Knot Step 7 of Instrument Square Knot
Step 5:
A second loop is made by placing the needle holder between the two strands and forming a loop with the long strand.		 Step 6:
The end of the short strand is grasped with the needle holder		 Step 7:
The strands are tightened under even tension as they are held close to the incision. The instrument square knot may also be tied by placing the needle holder on the outside of the two strands for each throw. However, placement of the needle holder between the two strands for one throw and exterior to them for the second throw will result in a granny knot.


Instrument Surgeon's Knot
Step 1 Step 2 of Instrument Surgeons' Knot Step 3 of Instrument Surgeons' Knot Step 4 of Instrument Surgeons' Knot
Step 1:
The instrument surgeons’ knot is tied in much the same fashion as the instrument square knot, but a double loop is placed around the needle holder.		 Step 2:
The short end is grasped in the needle holder.		 Step 3:
The hands are crossed and even tension is applied		 Step 4:
The first loop, when tightened, will not slip as readily as it does in the square knot.
Step 5 of Instrument Surgeons' Knot Step 6 of Instrument Surgeons' Knot Step 7 of Instrument Surgeons' Knot
Step 5:
The second loop is tied as a single throw around the needle holder, which is place between the two strands.		 Step 6:
The short end is grasped and pulled through the loop		 Step 7:
Even tension is applied to tighten the knot

Updated May 31, 2007 by SAK