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In contrast, two-throw square (1=1) or granny (1x1) knots can be advanced to the wound surface to secure precise wound edge apposition.

The addition of the second throw to the surgeon’s knot square (2=1) will provide additional resistance to wound disruption, but this knot will not advance by slippage, limiting the surgeon’s ability to secure meticulous coaptation of the wound edges. When the surgeon forms a double-wrap throw, the first throw of the surgeon’s knot square (2=1) can maintain apposition of the wound edged by “locking” or temporarily securing it in place by reversing the direction of pull on its “ears.” The “locked” double throw is notĪ reliable means of maintaining wound apposition because any tension applied to the “ears” from the patient’s side of the knot will unlock the knot. If there is some separation of the wound edges, the onethrow or two-throw knot can be advanced to reduce the size of the suture loop and thereby bring the wound edges closer together. Ideally, the knotted suture loop should reapproximate the divided wound edges without strangulating the tissue encircled by the suture loop. Once the throw or throws contact the wound, the surgeon will have a preview of the ultimate apposition of the wound edges. The purpose of the first step is to secure precise approximation of the wound edges by advancing either a one-throw or a two-throw knot to the wound surface. The second throw is formed by passing the free suture end up through the suture loop.ĭuring surgery, knot construction involves two distinct steps. Is formed by passing the free suture end down through the suture loop to create the first throw. The second throw is formed by passing the free suture end down through the suture loop. Square knot (1=1) (A) is formed by first passing the free suture end up through the suture loop to create the first throw.