Multiple suture techniques and instruments have been developed that have improved the patency rate of microsvascular anastomoses and have increased the ease and speed at which these anastomoses can be performed. In this paper we present a new method of knot tying that decreases the time required for anastomosis and therefore allows for less ischemia time of the flap.

The method developed uses the one suture end and the forceps to keep all sutures in the air therefore avoiding any contact with the vessels, surrounding structures including the vessel adventitia. This avoids the cumbersome attempts at picking a suture ends off surrounding structures and allows for less time spent stripping the adventitia off vessels.

The new method of knot typing will be demonstrated in a series of pictures and a short video clip