We differentiate between knots tied by hand and those tied making use of the needle holder (instrumental knots). The latter method uses less suture material than the first.
Hand-tied knots are used primarily when separate needle and thread are used and when there is tension in the wound. Instrumental knots are particularly suitable for use with a single strand of atraumatic suture material, with which multiple stitches can be made. A loop can be tied with the help of a needle holder at the start and end of an intracutaneous suture or a running suture.
Both types of knotting techniques rely on the same basic principles:
- A knot consists of multiple passes.
- Each subsequent pass is made in the opposite direction of the previous pass to prevent the knot from slipping.
- When tightening a knot, the ends of the thread must remain crossed until the knot is moved to its correct position.
- When tightening a knot, the ends of the thread must be parallel [Figure 37].
- Knots should be positioned above points of entry, rather than the wound itself.
- The edges of the wound must be approximated correctly when tightening a knot.
- If the knot is too tight, it can disrupt circulation and consequently lead to poor wound healing.
Figure 37