双手结.docVIP

2.双手结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 working end is passed from near to far over the MP joint of the left index finger forming a round loose loop. The index finger is kept immediately over the point of the knot.  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.  Swing the tips of the fingers cleanly through the loop from right to left. In order to learn proper technique, keep the plane of the loop oriented toward and away from you and pass the fingers perpendicular to the loop when practicing even though the resulting hand positions seem a little awkward. Once the proper pattern is established, you will learn to skew the the direction you pass your fingers. Pass the thumb through the loop all the way to the MP joint.  Place the working strand between the fingertips of the left hand.  Pass the working strand cleanly through the loop from left to right so that the crossing point of the strands is ove