a simple knot consists of 2 throws (3 for surgeon’s knot)
a secure knot (one that will not untie) requires additional throws depending on the suture material (eg. most monofilament suture materials require at least 4 throws)
for a continuous pattern, secure knots require:
one additional throw (ie. 5) for the beginning knot
one strand continues on after the knot is tied. Tension on this strand tends to unbalance the knot predisposing to untying.
two additional throws (ie. 6-7) for the end knot
tension of the continuous strand tends to unbalance the knot
use of a loop rather than a single strand to form one side of the knot further decreases knot security
extra throws beyond those required do not make the knot more secure, they just make it bigger
suture ends should be short to minimize foreign material, but at least 3 mm long to prevent untying of the final throw
