Knotting Expert Club Knots: step by step

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First throw (index-finger)

Square Knot (One-hand technique)

Sometimes one of the surgeon's hands is busy holding an instrument or the suture's needle. In those cases a "one-hand technique" will be used. Its advantage is that only one hand is used to tie the knot and the other hand never loses contact with the thread.
The technique is composed of 2 basic steps called "index-finger" and "middle-finger" techniques. Either of them can be chosen to perform the first throw of the knot.
The index-finger technique will be used here to perform the first throw.

02_Square_Knot_One_Hand_Technique_first_throw — Place blue strand over the tip of left index finger.

03_Square_Knot_One_Hand_Technique_first_throw — Place white strand over blue.

04_Square_Knot_One_Hand_Technique_first_throw — Pass white strand under the tip of left index finger (nail side).

05_Square_Knot_One_Hand_Technique_first_throw — Use left index finger to pull white strand under blue strand.

06_Square_Knot_One_Hand_Technique_first_throw — Pass the totality of white thread under blue strand.

07_Square_Knot_One_Hand_Technique_first_throw — Pull both strands in opposite directions (white down, blue up) to complete a single knot.

Second throw (middle-finger)

Square Knot (One-hand technique)

Once the first throw is completed using the index-finger technique, a second throw will be added using the middle-finger technique. It is important to remember that index- and middle-finger techniques should be used alternatively in order to obtain a correct square knot. Should the surgeon ave started the knot by means of the middle-finger technique, the next throw needs to be performed using the index-finger technique.