What Is a Surgeon's Knot?

Andrew Kirmayer

The way a surgeon ties a suture to close a wound can depend on different things. Wound shape and size can be a factor, while the material used often determines the best way to secure a suture. The surgeon’s knot can take various forms, while it is common to close a skin opening first with a square knot. A loop usually links the two sections of tissue, while the ends are tied together on the top surface; the ears of the knot are the ends which are cut.

Surgeon's knots are used to close wounds.
Surgeon's knots are used to close wounds.

A surgeon’s knot typically accounts for the most accurate line-up of the wound edges. The two sides are usually drawn together by pulling on the material. Afterward, the knot is secured until the surgeon is confident that it will not slip, which can cause the wound to open before healing. The final knot made at the end of a wound must often be tied more securely, because it is typically more prone to open. If the sutures open at one side, then the sides of the cut can come apart, whether it is surgical or the result of trauma.

The term “suture” is used to refer both to a specific technique for closing a wound and to the individual stitches involved in the wound closure.
The term “suture” is used to refer both to a specific technique for closing a wound and to the individual stitches involved in the wound closure.

There are various types of surgeon’s knot that are suited for different purposes. The concept of a surgical knot is often applied to fishing, in which lines are tied together. A double overhand knot is often used to hold together lines that are different sizes. Typically, a slight angle results from the turning, so this type can be a little larger than other knots. Rope can also be tied together with a bend knot, which a surgeon’s knot is a type of.

Techniques for tying a surgeon’s knot sometimes involve using two hands or just one.
Techniques for tying a surgeon’s knot sometimes involve using two hands or just one.

Techniques for tying a surgeon’s knot sometimes involve using two hands or just one. Each has a set of rules guiding what to do at the edges of the wound and loops, as well as how much force to apply in closing the knot. By using two hands, a surgeon typically has more control over the tension on each side of the suture. Depending on the technique, each tie can be a single or double wrap.

Materials used to make a surgeon’s knot often include nylon, polyester fiber, and polypropylene sutures, for example. Specific skills are often needed to tie an appropriate knot and close a wound. Step-by-step instruction is often part of surgical training, along with guidelines on how to use the different instruments involved in a wound-closing procedure.

Surgeon's knots can typically be used with any type of fiber included in the doctor's suture kit.
Surgeon's knots can typically be used with any type of fiber included in the doctor's suture kit.

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