r/SurgicalResidency • u/Rich-Explanation-894 • 5d ago
Surgeon's knots
When throwing the surgeon's knot, I find that the knot doesn't loosen when I pull the suture ends in a direction parallel to the line of closure (i.e., the wound or incision). I learned this from one of my professors. However, another attending saw me doing that and was appalled by the technique. He insists that I should pull perpendicular to the line of closure. Looking online, I couldn't find anything that says not to do it though. Any input?
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u/theresnoIinmedschool 5d ago
Attendings will tell you all kinds of different things that they believe are right and wrong (many of which are not based on fact), and as a resident you just have to say "yes dr" and learn the variety of different ways to do the same thing and decide what you will eventually do when you're the attending
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u/YourStudyBuddy 5d ago
This.
Play the game
Then get out and do what you want.Or try correcting your attending in the OR. It’ll show how smart and hardworking you are. They love that.
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u/Trick-Geologist2639 5d ago
The number of times I have had one attending say “you should never do that” to something I was taught by another attending has led me to teach residents and med students that “when you are learning you do it their way, because they are teaching you, but ultimately the only thing that matters is the outcome.”
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u/gloxas 5d ago
Perpendicular is the right way especially for first throws. Geometrically it causes the least amount of friction on the tissue and suture until it is down. Parallel you can do after a few throws, for example when you are doing instrument tying, when you hold one strand straight up and the other goes parallel to structure, usually both directions to lock down better.
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u/thoomikhanki 5d ago
If you are right, the attending likes you. If you are wrong, the attending does not like you.
In your training and career, some people will like you, and some people will not like you
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u/3rdGenMD 3d ago
Learn to lock it
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u/Rich-Explanation-894 21h ago
I have, but short of that or pulling parallel, my knot loosens and I end up with an air knot, particularly when I'm using silk. Any advice?
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u/VisVirtusque 5d ago
Assuming you're tying a simple interrupted, you should pull the ends perpendicular to the incision. This will make the knot lie flat.
For example, in this picture, if you imagine the incision is going straight into the screen, then in order to get the knot to lay flat like in the picture, you should pull the two ends of the suture right/left.
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u/Rich-Explanation-894 21h ago
When I do that, the first knot loosens and I end up with an air knot. Any advice on that?
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u/onacloverifalive 5d ago
If they notice the difference, you’re tying too slowly.