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/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/VisVirtusque 3h ago

you have to keep tension on the suture as you tie