Product Manual

Tension will be applied to the farther suture end in a
direction away from the surgeon. Conversely, and equal
opposing force will be applied to the closer suture end in
a direction toward the surgeon. After constructing
the second throw of these knots, the direction of the
suture ends must be reversed, with an accompanying
reversal of the position of the surgeon’s hand. As the
surgeon’s hands move toward or away from his body,
the movements of his right and left hands are in
separate and distinct areas that do not cross, permitting
continuous visualization of knot construction. With each
additional throw, the surgeon must reverse the position
of his/her hands.
Orientation of the suture loop in a plane that is
perpendicular to that of the surgeon’s forearms
considerably complicates knot construction (Figure 4).
In this circumstance, reversal of the position of the hands
occurs in the same area, with crossing and overlapping
of the surgeon’s hands, temporarily obscuring
visualization of knot construction. This circumstance
may be encountered when constructing knots in a
deep body cavity, which considerably limits changes
in hand positions. This relatively cumbersome hand
position may interfere with the application of uniform
opposing tensions to the suture ends, an invitation to the
conversion of a square knot construction to a slip knot.
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Figure 4. The surgeon’s hands frequently
overlap (arrows) when the orientation of
the hands is perpendicular to that of the
suture loop.