• 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:
    1. 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.
    2. 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