Surgical Knots

[Sweeney]

Like most people I have long been familiar with the "surgeons knot" - basically a reef or square knot with an extra tuck. Recently however I was asked for advice on a tying a small surgical item with a suture and incidentally came across what to me at least was a new area of knotting - "arthroscopic knots" such as the Revo knot and the SMC knot both used when repairing joints in the body. To most of us this is of academic interest unless you happen to be a surgeon or have a few inside you but interesting it is as a diversion from our usual discussions about rope knots. Some of the photos on the web are not for the squeamish but I have included one link as it has some clear diagrams (not photographs!) viz: www.promedms.com.br/superRevo_linvatecst.pdf.

Barry

[DerekSmith]

Barry,  I can hardly believe what you have just shown us ! !

'The Dark Ages' hardly does it justice - a 5mm screw in anchor and two bits of poly 'string' and the clumsiest array of 'knots' that the best knotting layperson would be proud of - it almost reminds me of this --



-- surely that great stack of hitches are going to chafe?
-- how long did it take the surgeon to tie that stack?
-- the price of a surgeon and staff and resource - all wasted waiting for a great junk of a 'Hurley hitch' to be tied
-- the added strain on the person being knocked out while these are being tied.
-- the hygiene issues around tying that thread.

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A few months back, one of my Greyhounds collected a gash about 30mm long on his shoulder.  A trip to the vet and two stitches were put in to hold the gash closed.  Within a day the stitches had cut through the skin and pulled right through.  The vets would not restitch so sent him home with instructions to just bath the open wound and let time scar it over.  Within another day, it had pulled open until it was about 15mm wide.  It was going to take some time to heal and would leave quite a scar.

I took a 2" length of micropore surgical tape (1" wide) and stuck it to one side of the gash about 1/8" from the edge, then did the same to the other side.  Then I pushed the edges together and put two 5mm steristrip sutures across the gash, sticking them to the micropore.  I then taped the sutures down with another strip of micropore.  The micropore held onto the skin over a relatively huge area - huge in comparison to the tiny area of contact the stitches were making.  The wound was effectively held closed along the whole of its length.  The steristrips are very strong and held the two sides together easily, even against normal flexing of a Greyhound in full 'extension'

Two days later he went back to the vets for a checkup and the wound was already healing rapidly.

The vet did a 'take two' and eventually said 'well, that is a novel solution'.  A week later, the 'patches' came off and the wound was healed (he is only 18 months old, so he heals like an express train).

Now the year is 2010.  Wouldn't you think our surgeons would be using some advancement on string and Hurley hitches to tie us back together?

Ideas on the back of a postcard please, or just post them here - do you mind Barry?

Derek

[Sweeney]

Not in the least Derek. Surely there must be methods of attachment less crude than this (sort of medical equivalent of cable ties - heresy though that may be here). I am due for a keyhole op at the end of March - I'll take my own cordage etc I think!

Barry

[Dan_Lehman]

One doctor I know insists that the so-called "Surgeon's Knot" is not
in fact used -- just Reefs (or capsized ones, effectively, as we see in
this fascinating document (thanks!).  I find the SMC knot intriguing.

Note how Reversed Hitches (Cow vs. Clove orientation) are favored
for locking effect.

Knotting via arthroscope or w/forceps, and in such sensitive situations:
not exactly the arena where Alpineer can work flamboyant magic 'a la
improved Butterflying, is it?

 

[sharky]

Derek,

where did you get that picture??? That looks like rope incest...almost as bad as the Johnny Walker Knot (tied by drunks)

[DerekSmith]

It was a bill hoarding lashed to a lamp post outside my house when the Circus came to town.  I would have liked to have taken it to pieces and seem how it was 'made', but everyone knows that you don't mess with the circus's women or their hoardings unless you want a visit in the dark of the night from the bearded lady called Harrold and 'her' nasty weasely mate called Jed  (every circus seems to have them).  As for the incest - your probably right there...

Derek

[Dan_Lehman]

It was a bill hoarding lashed to a lamp post ...

Although what is pictured seems to be only tangentially engaged
to that post -- I cannot discern any wrap, and if there is one,
behind other parts, it's still not the point of the knot.  Interesting
in that there are two free ends and four other parts.

The medical literature has a good bit of knotting information and
such articles are written in pretty formal, technical manner.  I've
only caught some glimpses of what goes on there.  I once had
an engagement with a doctor and proposed some novel structures,
which ultimately were dropped in favor of (for presenting at some
impending conference) a Clove Hitch (maybe the least novel knot!).
(The Clove was to be used in cloth tape to hold an endotracheal
tube in place (anchored around the head).  The other consideration
was for a tube to be held into the body, w/suture material; that was
the interesting hitch!)

--dl*
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