What’s our vector, Victor?   

Most surgical trainees look at their Chief and think, “Damn, you’re old,” because, in the middle of something important or complex the chief will say something random like, “what’s our vector, Victor?” The anaesthetist who is also as old as Mehtusulah will smile and this will prove to one and all that the Chief is a child of a bygone age. She really isn’t, she is just subtly trying to teach you about tying surgical knots properly, and why you should push into the wound not pull out of the wound. Vectors can be the difference between life and bleeding out horribly. Your Chief is wise.

“What’s our vector, Victor?” comes from an old (sic) film called “Airplane.” You should watch it, if only to understand why old people randomly say things like, “Surely you can’t be serious?” (I am. And don’t call me Shirley!) In terms of surgical knot tying understanding, vectors is everything. If you don’t you won’t understand why your knots are causing your Chief to sweat like Ted Striker. If you get vectors wrong, bad things will happen.

This post is not about how one throws a knot. That will be found elsewhere. It is about how one tightens a knot and uses vectors to both secure the knot and stop the tissue being ligated from being ripped out of a deep dark, soon to be filled with blood, hole. A vector is a quantity made up of force and magnitude; the amount you pull and the direction you pull in. 

If you throw a knot and pull up on both ends in two separate directions, out of the wound, the resultant vector (red arrow) will cause tearing of the underlying tissue upwards, away from whatever essential structure is in the deep. Worse, the knot will not be fully locked either.

If however, you hear your Chief’s voice in your head saying, “What’s our vector, Victor”  and then rotate one of the treads to push down on that, in completely the opposite direction from the pull out of the wound, the resultant vector will be a balance of both of these forces, ideally zero (red dot). Nothing will move with the exception of the knot locking and your Chief being impressed. (They won’t say they are impressed, they expect this.) But if you can achieve this, somewhere, deep inside, something will change, all because of vectors. What’s our vector, Victor? Roger, Roger.