Product Manual

Hand tying of knots can be accomplished by either the two-hand or one-hand

technique. Each technique has distinct advantages as well as drawbacks. The two-hand

technique of knot tying is easier to learn than the one hand. An additional advantage

of the two-hand tie is that the surgeon can apply continuous tension to the suture

ends until a secure knot is formed. With the one-hand method, it is often difficult to

maintain tension on the suture ends during the formation of the knot and slippage

of the first or second throws will be encountered, especially by the inexperienced

surgeon. When the surgeon attempts to shorten the resultant enlarged loop by

advancing the knot, breakage of the suture may occur, requiring passage of another

suture through the once punctured tissue. The student of surgery should master first

the construction of square type knots because knot security can usually be achieved

with fewer throws than the granny-type knots.21 The additional foreign bodies

required to form a secure granny knot, predisposes the wound to the development

of infection.

The hand-tying techniques illustrated in this manual are those used by right-handed

individuals. Using the two-hand technique, he/she constructs the knot predominantly

with his/her left hand, which forms a suture loop through which the free suture end

is passed. The left hand continually holds the suture end until knot construction

is complete. In contrast, the right hand merely holds, lets go, and regrasps the free

suture end. If the surgeon inadvertently manipulates the fixed suture end with his/her

right hand, he/she will be passing either the needle or reel through the formed loop.

The latter case is an invitation to needle puncture.

Many right-handed surgeons prefer to manipulate the free end of the suture with

their left and during two-hand ties. In such cases, the right hand performs the major

manipula-tion of the suture during formation of the loop. An advantage of this

hand tie