• the knot is the weakest part of a suture line
  • knot security depends on
    • the technique used to tie the knot
    • the physical characteristics of the suture material
  • throw is the motion of wrapping the strands of the suture around each other and pulling on the ends to tighten them
    • simple knot consists of 2 throws (it tends to untie when under tension)
    • secure knot requires at least 4 throws (specific number varies with how slippery the suture material is)
    • for continuous patterns, 5-6 throws are placed on the beginning knot while 5-7 are placed on the ending knot
      • Additional throws are needed because of :
        • extra tension on the knot
        • addition of an extra strand because a loop is tied instead of a single strand
    • ends of the suture should be left long enough that they do not untie (at least 3 mm, but varies with the suture size and material)
  • first, become consistent at using the proper technique to tie a good knot, then work on speed