The two strands of the suture material are oriented toward and away from the operator to avoid the necessity of crossing the hands or the strands during the tie. The long end (yellow) is away from the operator for the first throw in this case and is held with middle, ring and small fingers of the left hand. The left hand always grasps the long (needle/non-working) end, whether it starts toward or away from the operator. The same three fingers of the right hand hold the short working end. In the operating room, the strands are grasped at a distance that places the tips of both index fingers just at the point of the knot. For practice, the strands are left longer. The thumb and index fingers of both hands are always left free to manipulate the strands. The index finger of the left hand (away from the operator, corresponding to the strand held by the left hand) is passed between the two strands all the way up to the MP joint.
The tips of left thumb and index are pinched together forming a circle. Do not place the flats of the tips together or scissors the fingers as these moves decrease the ability to cleanly pass the fingers through the loop.
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