![]() 6–8 In studies 6–8 that evaluated complications observed during and after ovariohysterectomy and ovariectomy performed by veterinary students, hemorrhage from an ovarian pedicle occurred in 4% to 9% of dogs. 1–5Īlthough postoperative complications following ovariohysterectomy are relatively uncommon and intraoperative bleeding during this procedure rarely results in life-threatening postoperative hemorrhage, it remains the most common cause of postoperative death in dogs. Although several vessel ligation modalities, including stapling equipment, electrosurgical vessel sealing devices, harmonic scalpels, resorbable polydioxanone cable ties, and vascular ligation clips, have been evaluated, ligation with suture remains a cornerstone for hemostasis for many veterinary surgeons. Secure ligation of vasculature is essential in surgery, including commonly performed procedures such as ovariohysterectomy, ovariectomy, orchiectomy, splenectomy, nephrectomy, liver and lung biopsy and lobectomy, and limb amputation. The surgeon's throw was less reliable as a first throw for vascular pedicle ligation in the model tested.īleeding associated with surgery is a potentially serious complication, and hemostasis is vital for a successful outcome. In vitro results suggested that, when constructed correctly, these friction knots may be preferable first-throw constructs during vascular pedicle ligation and should be further evaluated for clinical use. The Miller's knot, constrictor knot, and strangle knot had mean leakage pressures > 360 mm Hg regardless of model diameter, whereas the surgeon's throw, Ashley modification of the Miller's knot, and modified Miller's hand tie consistently leaked at pressures at or below those found in arteries under normal physiologic conditions (pressures of 90 to 140 mm Hg).Ĭonclusions and Clinical Relevance-Security of the Miller's knot, constrictor knot, and strangle knot was considered excellent. Results-Mean leakage pressure for the surgeon's throw was significantly lower than that of all other knots tested in both pedicle models. Results were compared by means of ANOVA and Student t tests. Each knot configuration was constructed around each of 2 balloon dilation catheters used as small- and large-diameter vascular pedicle models and pressure tested to failure (leakage) 10 times. Procedures-Security of the surgeon's throw, Miller's knot, Ashley modification of the Miller's knot, modified Miller's hand-tie, constrictor knot, and strangle knot was evaluated. Sample-20 constructs of 6 friction knots created with 2–0 polyglyconate suture. Objective-To compare in vitro security of 6 friction knots used as a first throw in the creation of a vascular ligation. A 15-cm length of monofilament absorbable suture (2–0 polyglyconate) was used to create all knots evaluated in the study the knots shown were constructed with 3-mm multifilament braided rope to improve understanding of proper knot construction. Care is taken to ensure that the overriding turn is positioned directly over the top of the underlying overhand knot if this position is not maintained, the knot becomes markedly less secure. E-Equal tension is placed on the standing and working ends in opposite directions to tighten the knot. D-The working end is passed beneath both strands comprising the crossed round turn in parallel orientation to the pedicle. ![]() C-A turn of the working end over the top of the standing end brings the working end to the outside of the knot. ![]() The working end is brought to the inside of the standing end directly beneath the cross. ![]() B-An additional half turn of the working end creates a crossed round turn (a turn with an additional half turn resulting in the working and standing ends facing in the same direction). A-The working end of the suture (the end used to construct the knot) is passed around the pedicle and crossed over the top of itself (white dashed arrow) to create a turn (a wrap of suture around a pedicle after which the working end and standing end are facing in opposite directions). Step-by-step illustration for construction and tensioning of the strangle knot.
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