Surgeon’s Knot

                               Surgeon’ s Knot

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

                           Photography by Michael J. LaMorte

The surgeon’s knot is useful when the wound edges that are being approximated are
under tension and have a tendency to pull the first throw of the square knot apart.
The surgeon’s knot is identical to a standard square knot, except that the
first throw is constructed by wrapping the short strand around the long
strand twice instead of just once. The second wrap creates enough additional
friction that there is less tendency for the first throw to loosen before the second
throw can be brought down.

The surgeon’s knot is begun just as one would begin a square knot. The thumb of the left hand is positioned behind the long strand and moved to the right to initiate formation of the first loop.
The right hand has brought the short strand across the long strand toward the surgeon to form the first loop. Note that the left thumb protrudes from the loop. The left index finger is touching the thumb and will be rotated down into the loop.
The left index finger has been rotated into the loop, and the the right hand is about to place the short end between the thumb and index finger of the left hand.
The left hand has been rotated counterclockwise to bring the short end up through the loop to create the first wrap around the long strand.
The right hand regrasps the short end, and the index finger of the left hand is rotated clockwise into the loop a second time.
The short end is once again placed between the thumb and index finger of the left hand…
… and the left hand is rotated counterclockwise a second time, bringing the short end up through the loop again to create a second wrap around the long strand.
The right hand then regrasps the short end and pulls it toward the surgeon to approximate the wound edges with a flat, double-wrapped throw.
The second through of the surgeon’s knot is identical to the second throw of a standard square knot. The second throw is initiated by moving the long strand to the right with the left index finger.
The short strand is then brought to the left, beneath the long strand, and then up and away from the surgeon to create the second loop with the left index finger inserted down into the loop. The left thumb touches the index finger so the index finger can guide the thumb up through the loop.
The left thumb has been rotated up through the loop, and the short strand is placed between the thumb and index finger of the left hand.
The left index finger and thumb are being rotated clockwise through the loop, bringing the short end with them.
The short end is then regrasped by the right hand…
… and the second throw is tightened by pulling the short end away from the surgeon, pulling at 180o against the long strand. A 3rd throw (which is a normal single-wrapped 1st throw) will be added for knot security.
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