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Extra resources for Kaplan USMLE Step 2: Orthopedic Surgery
Sample text
Do not let your assistant undo all your safety precautions by cutting the threads too short. Have the ends of silk, linen, or braided materials cut 2–3 mm long, and monofilament materials cut to 4–5 mm. Fig. 52 While your assistant lifts the handles of the forceps, pass the ligature from one hand to the other behind them. Fig. 53 Stretch the thread between your hands beyond the forceps and have your assistant reach over the thread to pick up the handle of the forceps. Fig. 54 Stretch the ligature thread between the tips of your index fingers to depress it and encircle only the vessel, without including the tips of the forceps.
If you tie one half-hitch left over right and on top of it tie a second half-hitch also left over right, you produce a granny knot (Fig. 5). You could also tie two halfhitches right over left, right over left. A granny knot has much greater holding power than a single half-hitch. Fig. 2 Forming a half-hitch. Cross the threads and pass one end under the crossing to emerge on the other side. OR 8 Fig. 5 Granny knot. Follow the path of the threads; for the first half-hitch, the left thread was passed in front of the right one, then underneath, to emerge in front on the right side.
If you merely pull on the deep structure you may damage it, or pull off the tie. LIGATURES A ligature (L ligare = to bind) is tied round a structure, most commonly a blood vessel or other duct, usually intended to close the lumen. Ligatures are secured by knotting the ends. Ligatures Key points • Blood vessel ligation is one of the commonest repetitive procedures in surgery. • Practise, practise, practise ligating vessels until you can perform it effortlessly, perfectly, every time. • Perfection is more important than time.
Kaplan USMLE Step 2: Orthopedic Surgery
by John
4.1