One Hand Tie

One Hand Square Knot

Wayne W. LaMorte, M.D., Ph.D., M.P.H.

Photography by Michael J. LaMorte

Two hand ties are generally preferred by most surgeons, but one hand ties can also be used.

1) Note that the short end has been placed beneath the tubing and is held in the right hand, away from the surgeon. The long strand is held in the left hand.

2) The right index finger initiates formation of the first loop by pushing the short strand to the left and above the long strand. The left hand begins to move the long strand to the right.

3) The right index finger is shown inserted into the loop that has been created.

4) The right index finger now begins to roll behind the short strand, which is still being grasped by the thumb and middle finger.

5) The end of the short strand has now been released by the right thumb, and the index finger is being used as a lever to rotate the short end up through the loop.

6) As the short end emerges from the loop, the middle finger pinches it against the forfinger to re-grasp it.

7) And the throw is tightened by pushing the long strand away… and pulling the short strand toward the surgeon with equal tension. Note that tension is applied by pulling the two strands in opposite directions at an angle of 180 degrees.

8) As the second throw is initiated, the short end is toward the surgeon and is being grasped by the thumb and index finger.

9) The right index finger and thumb continue to grasp the short end, as the middle and ring fingers are placed behind the short end to begin creating a loop. The left hand has begun to bring the long strand toward the surgeon.

10) The right hand has supinated slightly …

11) … as the left hand brings the long strand toward the surgeon and across the short strand to form a loop.

12) The right middle finger has now been flexed so it can slide behind the short strand.

13) The right middle finger is now behind the short strand, which is still being grasped by the thumb and index finger.

14) The right middle finger is now used as a lever to rotate the short end away from the surgeon.

15) The short ended is released by the thumb, but the ring finger pinches the short end inside the loop by squeezing it against the middle finger.

16) The short end is now drawn through the loop away from the surgeon by the middle and ring fingers.

17)

18) As the short end moves through the loop, the thumb squeezes it against the middle finger.

19) Finally, the short end has been re-grasped with the right hand and pulled away from the surgeon as the left hand pulls the long strand to secure the second throw.

20) The 3rd throw is initiated in the same way as the 1st throw, by pushing the short end to the left with the right index finger.

21) The left hand brings the long strand to the right, beneath the short end.

22) The right index finger is inserted into the loop that has been created.

23) And the right index finger rolls behind the short end in order to rotate it up through the loop.

24) The short end has emerged from the loop and has been re-grasped by the right hand.

25) And the 3rd throw is secured by pulling the short strand toward the surgeon, as the long strand is pulled away at an angle of 180 degrees.