Hello!
Never heard any French surgeon name this binding knot "noeud de chirurgien", but almost always "flat knot" if not simply "a knot".
Post is strictly limited to :
- That particular binding knot
- In that particular usage ( since the surgeon's qualifier narrow it down to that only)
- And to my personal experience and training. ( in the late 60's and eraly 70's)
There are new cunningly deviced "sliding knots" that "endoscopic surgery" made mandatory.
Really interesting but in a sphere of their own.I have only theorical knowledge of them. In their particular case it is may be "justifiable" to have a name for each of those sliding nooses.Cannot have an opinion. Would that an American doctor would do a post and pics on them.
Mind mapping :
- ligature = the "ultra thin rope" used
- suture = the act of closing a cut with a "sewing"
- procedures : the numerous differents ways to dispose the ligature before closing the cut's lips with a binding knot.
That was the procedure that got named during my training, because that is where the "information" on what to do is.
The bight is buried in tissues and you are left with 2 working ends.
In fact it is simply :
- a double overhand knot secured by a square knot
Or
- a square knot with a double overhand securing it
- or best a square knot secured by another square knot.
NEVER two double overhand, NEVER a triple overhand ANYWHERE in the knot and certainly not two of them and NEVER a granny's ANYWHERE (in French we call the granny's ="noeud de vache" that is a cow's knot, don't ask me why) .
In French a "square knot", is a "noeud plat" ( wording in French means :"flat knot")
That "flatness" is quite important to get "the magic" of this knot : less attrition of an already traumatized zone and less risk to have too localized pression provoking small eschares.
Knot must stay put with "just the right" tension.
If not enough then very bad result ; too much and you get "the cutting effect" as ligature slice through tissues. Pulling too "hard" is "lethal"for very thin ligatures.
Only reason for the first double overhand knot is that it play the role of the finger that hold in place the first overhand.
Double overhand cause higher friction ( but that is its downfall with very small gauge ligature); "braking" effect is put to good use while doing the securing flat knot.
No justification for a triple overhand followed by another triple or double overhand; no need for two double overhand.
Time consuming ( and lenght of operating time is a crucial factor in cicatrisation) for no good reason, and too many ligatures breaking!
Succeed in doing that sort of "bad" knot, then you get a very "cork-screwing piggy tailed" sort of knot that paradoxically tend to undo itself under the torque if done with finer ligature, and if you tightened them overmuch : ligature break or worse "cutting effect" ( not always evident to see but with secondary "lachage de suture" ( a capital sin in surgery,sometimes a mortal sin paid by the patient.
But we are also taught : "bury your errors!" ( emergency/operating room gallow laugh only!)
Do not tighten the knot by pulling and spreading out the two working ends in a sort of "opening of the compass" : shearing guaranteed with many ligatures.
Hold one end almost verticaly while maintening the other end under tension and pushing ( handsomely as sailors of old would have said) with the pulp of your index to make the double overhand slide along the vertical end.
Then without ever letting the tension slacken you "apply closely" the overhand on the tissues.
If there is no"slipping"and not"too much tension" on the tissues while you are doing the knot it is better to do 2 square knots one following the other as in #462 ( always "primun non nocere" your knot must be the less "tissue traumatic that is possible.
If my explaining is not clear then please ask and I will try to clarify what you find obscure.
A friend, a buddhist monk is fond of saying "words are only heard by the ears, they must be heard by the heart ( meaning that they must be "experienced from within") or it is just so much water poured on a duck's head"
Experiment and draw your own conclusions.
There is a fast and clever way to use your hands and fingers.
Time for a little experimenting :
After looking at my album at
http://fr.pg.photos.yahoo.com/ph/innominedarnold/album?.dir=648a&.src=ph&store=&prodid=&.done=http%3a//fr.pg.photos.yahoo.com/ph//my_photostry each one of the knots shown ( last to be tried is the "MY")
To make it a realistic experiment :
- ask a friend with hairs at least 20-25inches long to sacrifice a dozen of them on the Altar of Experimental Knowledge
- Mount one hair in the finest needle you can find . After or before, hair, experiment very fine fishing nylon line.
- Have some spaghettis on hand : "al dente" not over cooked as that will make it more difficult and less "realistic".
- or cut a slice of ham in two parts and then suture the two parts back to one slice.
- Same with the next roast : borrow it,make a cut an inch wide and deep and experiment.( yes I am all for peace in couples! sure!)
- put on some close fitting latex (or some such subtance) gloves then plunge both of your gloved hands in a very soapy water (mimicry the "sliding" effect of blood and serosities)
Then stich 2 spaghettis together.
In case you are wondering : I was trained by many differents surgeons and 2 of them had American surgeons taking a 2 or 3 days round trip just to see them performing.
I was told by one of the visitors ( only one source! a pity) that this binding knot "MY" was taken back to America in the aftermath of WWI, by military surgeons taught by their French and English counterparts in the field hospitals of 17-18.
If any one have validated documentation on that assertion I would like to have it.
