Tying the Two Handed Surgical Tie, Pushing Technique
With the short end away from you, hook your index finger between the ends. Grip the end with your thumb, push it through, and pull it tight to make a Half Knot. Next, hook your thumb between the ends. Grip the end with your finger, push it through, and pull it tight to complete the Square (Reef) Knot.
Surgical Tie, Two Handed
Uses: The Surgical Tie is a Square (Reef) Knot (ABOK # 460, p 75.) It is widely used in surgery although less secure than the Ligature Knot, which starts with an initial Double Throw Knot.
Techniques: In the Two Hand technique the end of the suture is Pushed through to form the knot. The distinctive feature of a surgical tie is that the technique keeps the ends taut during the tying process. This maintains tension in the first Half Knot while the additional locking half knot is being tied. Alternative techniques include the One Hand Technique, the Instrument Tie, and the Surgical Slip Tie.
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.
Variations: Some descriptions show additional steps for each part of this technique. For the first part, prior to using the finger as a hook, the thumb is inserted, then pressed against the finger, and the two are rotated into the position shown in frame 3. Likewise for the second half, the finger is first inserted, then pressed against the thumb, and the two are rotated into the position shown in frame 10. These are additional steps to learn and remember and provide little or no practical advantage.
Repetition: The sequence shown in the animation is usually repeated to provide security. This precaution is appropriate because Square Knots are notoriously unreliable and because the completed knot is often hard to see – it could comprise a stack of slippery Half Hitches instead of the intended Square (Reef) Knot.
Reversing the Sequence: The animation shows the short end away from the surgeon with the finger being used to make the first "hook". If the short end starts towards the surgeon then use frames 9 to 14 first with the thumb making the "hook" for the first Half Knot followed by Frames 3 to 8 using the finger for the second Half Knot.
