Dr Amanyu

Plastic and reconstructive surgery resident, musician, artist. Big on poetry, speedcubing, ambigrams, animation, VFX, webdesign, MH, #FOAMed

[Dr Amanyu @melodicscalpel]

Just wrapping up a sketch I had made a long time ago... #PencilSketch #drawing #artistsontwitter #artwork #paediatricseffect

[Dr Amanyu @melodicscalpel]

I remember having come across some studies of EMG responses and fatiguabilty of forearm muscles in palming vs tripod grip (mostly in the context of lap I think) can't recall that fully... But more such in depth studies are wanting, I believe

[Dr Amanyu @melodicscalpel]

But I believe "palming" is ergonomically superior to the "tripod" grip. For one thing, it makes the instrument more coaxial to the supination-pronation axis. Also brings the index finger (effort) closer to the jaws (load), thereby increasing stability (↑MA) & hence precision

[Ron Barbosa MD FACS @rbarbosa91]

Surgery residents:

Some attendings may insist that you 'palm' the needle holder, but the 'fingers-in-holes' method is also perfectly acceptable...shown here are photos of this grip being used by:

Denton Cooley, Michael DeBakey, Harvey Cushing, Norman Shumway, and Mont Reid.

[Dr Amanyu @melodicscalpel]

...& smoother cerebellar error correction ig. But with finer instruments like Derfs and suchlike, it wouldn't matter that much.
Also in situations like, say, continuous sutures (Cambridge twist) palming has a clear advantage, is more efficient, and is the only way to go I'd say.

[Dr Amanyu @melodicscalpel]

@rbarbosa91 *ergonomic

[Dr Amanyu @melodicscalpel]

@rbarbosa91 But I personally think "palming" is more ergonomical than the "tripod" grip. For one thing, it makes the instrument more coaxial to the supination-pronation axis. Also brings the index finger (effort) closer to the jaws (load), thereby increasing stability(↑MA) & hence precision

[Dr Amanyu @melodicscalpel]

@rbarbosa91 I remember having come across some studies of EMG responses and fatiguabilty of forearm muscles in palming vs tripod grip (mostly in the context of lap I think)... can't recall that fully... But more such in-depth studies are wanting, I believe

[Dr Amanyu @melodicscalpel]

@rbarbosa91 ...& smoother cerebellar error correction ig. But with finer instruments like Derfs and suchlike, it wouldn't matter that much.
Also in situations like, say, continuous sutures (Cambridge twist) palming has a clear advantage, is more efficient, and is the only way to go I'd say

[Dr Amanyu @melodicscalpel]

Hi wonderful people of #SurgTwitter!✨
Just a quick tweetorial 🧵 on some
🚨Principles of surgical knot tying🚨
#MedTwitter #MedX #MedEd #medstudenttwitter #surgery

Before we begin, which of these knots do you think is the best as a ligature?

[Dr Amanyu @melodicscalpel]

@VinayakRengan Yay sir! Awesome!!😁😁 😎
Sir did you see this video↓ .. it's easy to make this on, say, a hemostat and use that to clamp the vessel with the knot already loaded onto it.
Thank you for trying it sir!
https://t.co/sWpMKNMppQ

[Dr Amanyu @melodicscalpel]

✨The constrictor knot - instrument tie✨
Follow along!
It may not be the ideal knot for every scenario, but wherever you can "clamp→(cut)→ligate", you can use this.
(and please pardon my accent😅)
2/3

[Dr Amanyu @melodicscalpel]

Video Tweetorial🧵
The 💥CONSTRICTOR KNOT💥 is one of THE BEST knots for ligation (more secure than even the surgeon's knot, RHAP, and suchlike)
Here's the quickest and most efficient way of tying it in SURGERY
#MedTwitter #MedX #MedEd #SurgTwitter
1/3
https://t.co/EP0jfRh6yE

[Dr Amanyu @melodicscalpel]

Hi wonderful people of #SurgTwitter!✨
Just a quick tweetorial 🧵 on some
🚨Principles of surgical knot tying🚨
#MedTwitter #MedX #MedEd #medstudenttwitter #surgery

Before we begin, which of these knots do you think is the best as a ligature?

[Dr Amanyu @melodicscalpel]

@mowwyjane Awww he's so adorable 🥹💞

[Dr Amanyu @melodicscalpel]

@imacuriosguy Thank you so much for your kind words sir!! 🙏 Yeah sir, it's a very interesting knot 😊

[Buitengebieden @buitengebieden]

Pawsonal trainer.. 😂

[Dr Amanyu @melodicscalpel]

@VinayakRengan Thank you so much sir! That really means a lot to me!💛

[Dr Amanyu @melodicscalpel]

@bijlanirajesh @rbarbosa91 @stevenbollipo @Lap_surgeon @imacuriosguy @VinayakRengan @sminaev2015 @shouldergeek @amitsurg @CelestinoGutirr @BrennanSurgeon @chriscraigCCC @santalum_aurum @stethospeaks @beckybeckyfish @aribindi @SurgeryBro @HaryaxPathak @drnngujarathi @NurseTexas1 Yeah sir.. thank you!!

[Dr Amanyu @melodicscalpel]

Here's the constrictor knot tutorial

https://t.co/oQisfrza0o

[Dr Amanyu @melodicscalpel]

Video Tweetorial🧵
The 💥CONSTRICTOR KNOT💥 is one of THE BEST knots for ligation (more secure than even the surgeon's knot, RHAP, and suchlike)
Here's the quickest and most efficient way of tying it in SURGERY
#MedTwitter #MedX #MedEd #SurgTwitter
1/3
https://t.co/EP0jfRh6yE

[Dr Amanyu @melodicscalpel]

Hi wonderful people of #SurgTwitter!✨
Just a quick tweetorial 🧵 on some
🚨Principles of surgical knot tying🚨
#MedTwitter #MedX #MedEd #medstudenttwitter #surgery

Before we begin, which of these knots do you think is the best as a ligature?

[Dr Amanyu @melodicscalpel]

The constrictor knot is also a very fast and easy knot to tie inspite of being one of the most secure. I'll soon post a tutorial on how to tie the constrictor knot efficiently in surgery.
Have a wonderful day y'all! :)
fin.

[Dr Amanyu @melodicscalpel]

@rbarbosa91 This is the technique... The first tweets's just an introduction
https://t.co/4Rda6KemO9

[Dr Amanyu @melodicscalpel]

✨The constrictor knot - instrument tie✨
Follow along!
It may not be the ideal knot for every scenario, but wherever you can "clamp→(cut)→ligate", you can use this.
(and please pardon my accent😅)
2/3

[Dr Amanyu @melodicscalpel]

@rbarbosa91 Just did!😁
Yeah you're right it's close to impossible for deep ties I guess. But as long as you can cut the structure and the slide the knot onto it, this method workds great.
Would greatly appreciate if you could share this.
And thank you so much!!!😊
https://t.co/BZzWBthyv4

[Dr Amanyu @melodicscalpel]

Video Tweetorial🧵
The 💥CONSTRICTOR KNOT💥 is one of THE BEST knots for ligation (more secure than even the surgeon's knot, RHAP, and suchlike)
Here's the quickest and most efficient way of tying it in SURGERY
#MedTwitter #MedX #MedEd #SurgTwitter
1/3
https://t.co/EP0jfRh6yE

[Dr Amanyu @melodicscalpel]

@rbarbosa91 @stevenbollipo @Lap_surgeon @imacuriosguy @bijlanirajesh @VinayakRengan @sminaev2015 @shouldergeek @amitsurg @CelestinoGutirr @BrennanSurgeon @chriscraigCCC @santalum_aurum @stethospeaks @beckybeckyfish @aribindi @SurgeryBro @HaryaxPathak @drnngujarathi @NurseTexas1

[Dr Amanyu @melodicscalpel]

Comes in handy a lot especially if you don't have someone assisting, to hold the forceps for you.
And given how quick and easy this knot is to tie inspite of being one of the most secure, I think we need to be teaching this more. Please share!
Wishing you a wonderful day! :)
3/3