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The time consumed in tying sutures and ligatures during many surgical operations is too great in proportion to the time taken to do the rest of the work. The circumstances under which ligatures must be tied often render the work most difficult and unsafe when done in many of the ordinary ways. The very fine ligature material often used, gloved fingers covered with blood and other fluids, deep and small cavities, the short time one has at command, and the great importance of the security of the knot change a very simple task into one of great moment.
A knot to be of the greatest value must be one which will not slip or cut the ligature while being tied; it must be simple, requiring few and uncomplicated movements to produce it. It must be made in such a manner that both ends of the ligature are held in the
CASTLE HE, RYFKOGEL HAL. AN EFFICIENT AND TIME-SAVING METHOD OF TYING THE SQUARE KNOT. JAMA. 1911;LVI(14):1020–1021. doi:10.1001/jama.1911.02560140006004
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