Tying the One Handed Ligature, Pulling Technique
With your index finger hook the long end. Pull the short end under it and through. Hook it again and pull the short end through. Tighten the Half Knot. Lay the short end, then the long end, over your hand. With your middle finger hook the long end. Pull the short end under it and through. Pull tight to complete the Ligature.
One Handed Ligature, Pulling Technique
Uses: The Ligature Knot (ABOK # 1209, p 221) is widely used in surgery because the added throw in the first Half Knot makes it more secure than the Square Knot.
Better Alternative: Recent experiments compared several ligatures suitable for use in surgery. They convincingly demonstrated that the Constrictor Knot had the best properties and was far less prone to slipping.
Techniques: In the One Hand technique the end of the suture is Pulled through to form the knot. Alternative techniques include the Two Hand Technique and the Instrument Tie. As with the Surgical Tie correct technique should keep the ends taut during the tying process.
Learning and Teaching: Most right-handed students will prefer the Normal view and left-handed students the Mirror view. An Instructor sitting opposite a student may find it helpful to use the Inverted or Rotated views.
Repetition: The sequence shown in the animation is usually completed with additional half knots to provide security. This precaution is appropriate because knots are unreliable and because the completed knot is often hard to see – it could comprise a stack of slippery Half Hitches instead of the intended Surgical Knot.
Reversing the Sequence: The animation shows the short end away from the surgeon with the index finger pulling first in Frames 2 to 12. If the short end is towards the surgeon then use Frames 13 to 19 twice in succession to tie the double throw of the first Half Knot followed by Frames 2 to 6 to tie the second Half Knot.
