Pull the R hand upwards and the L hand downwards.Pick up the end of the long thread with the R thumb and index finger Outside of the cavity, pick up the end of the short thread with the L thumb and ring finger, with the remainder of the thread passing over the L index and middle fingers.It is essential the knot is tied firmly to avoid slipping, whilst upwards pressure is avoided to prevent tearing of the tissue. Tying at depth is used for knot tying deep within a body cavity. Adjust the final tension of the knot as necessary.Repeat the same manoeuvre as before with the short thread facing upwards and the long thread facing downwards. ![]() Pull the L hand upwards and the R hand downwards, allowing the knot to rest in position adjust the tension of the knot as necessary.Repeat the same manoeuvre as before, passing the short thread under and over the long thread.Pick up the long thread with the R thumb and index finger and bring downwards, to align next to the short thread Come back upwards with the short thread, by holding the end with the L thumb and index finger.Pull the R hand upwards and the L hand downwards, allowing the knot to rest in position adjust the tension of the knot as necessary.Using the L middle finger, whilst still holding the end between L thumb and ring finger, pass the short thread under and then over the long thread.Bring up the long thread with the R hand, to align next to the short thread.Pick up the end of the short thread with the L thumb and ring finger, with the remainder of the thread passing over the L index and middle fingers.Start with the short thread facing upwards and the long thread facing downwards.Tighten the knot and slide it on the standing line to adjust tension.The square surgeons knot is the most reliable and well-known for nearly all suture materials.Make one additional coil around the standing line on the outside of the coils just made. ![]()
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