(7) Tying the knot: instrument ties. Follow this procedure for making
(a) Make the suture loop in the usual manner.
(b) With the non-dominant hand, hold the end of the suture that is
swagged to the needle.
(c) Pull on the suture until the free end on the other side of the wound
is two to four centimeters in length.
(d) With the dominant hand, hold the needle holder.
(e) Loop the swagged end of the suture twice around the needle holder
for nonfilament suture material. A single loop suffices for most braided sutures such as
silk or DexonR.
Grab the free end of the suture with the blades of the needle
(g) Cross the hands so that the hand holding the swagged end is on
the far side, and the hand holding the needle holder and the free end are on the near
side of the wound.
(h) As you clinch the first throw of the knot, pull upward on the suture
(i) Adjust the tension of the first throw, so that the wound edges come
together snugly, but not tightly.
(j) For the second throw of the knot, the needle end is on the far side
of the wound, and the free end is on the near side of the wound.
(k) Hold the needle end of the suture in the non-dominant hand and lay
the needle holder on top.
Loop the suture only once around the needle holder.
(m) Grasp the free ends with the blades of the holder.
Cross the hands so that the sutures intertwine smoothly.
Cinch down the throw.
Take care not to cinch down too tightly on the second throw, because
the tightness will be transmitted to the wound.