title: The practice of knots untying technique using a 10-0 nylon suture and gauze to cope with technical difficulties of microvascular anastomosis.
abstract: BACKGROUND
  We report a training technique of microvascular anastomosis readily accessible for trainees engaged in busy day-to-day clinical practice.
  
  
  METHODS
  A table-top microscope is prepared on a table and 10-0 nylon suture (nonsterile) is used to tie two adjacent gauze fibers to form successive knots. In a second step, the knots are untied using the suture needle, which we call the knots untying technique (KUT). As the tied knots face different directions, it is difficult to guide the needle accurately through the knots without damaging or breaking the suture. And to untie all the knots within a certain time period, high controllability is required.
  
  
  RESULTS
  The practice of KUT will allow surgeons to improve their ability to accurately guide the needle from any direction and carry out precise suturing swiftly, which will prevent vascular wall dissection during microvascular anastomosis or inability to guide the needle to a target point because of physiologic tremor.
  
  
  CONCLUSIONS
  In our experience of training young neurosurgeons, practice of KUT contributes to shortening the duration of blood-flow blockage and helps mastering the technique of successful microvascular anastomosis.
authors.affiliation: Department of Neurosurgery, Showa General Hospital, Tokyo, Japan. tamamanya@energy.ocn.ne.jp
authors.forename: Masahiro
authors.initials: M
authors.lastname: Indo
authors.forename: Kazuo
authors.initials: K
authors.lastname: Tsutsumi
authors.forename: Masahiro
authors.initials: M
authors.lastname: Shin
mesh_terms: D000714:Anastomosis, Surgical / Q000193:education* / Q000295:instrumentation / Q000379:methods; D002548:Cerebral Revascularization / Q000193:education / Q000295:instrumentation / Q000379:methods; D006801:Humans; D008866:Microsurgery / Q000193:education* / Q000295:instrumentation / Q000379:methods; D013536:Suture Techniques / Q000193:education* / Q000295:instrumentation; D013537:Sutures / Q000592:standards*; D013663:Teaching / Q000379:methods*