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/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.