This creates greater internal friction between the lines and is therefore less likely to slip. But in a square knot, the red lines are on the same side of the blue hook and the blue lines are the same side of the red hook: the knot is square (symmetric). The granny knot in the picture shows the red lines split on different sides of the blue hook, and on the opposite side the blue lines split the red hook. A granny knot is the result of making the same throw or hitch twice, whereas a square knot is the result of making two opposite throws or hitches in a row. Note that a square knot and a granny knot look very similar, but are fundamentally different. What’s a flat and square knot? Well, to start with, let’s understand what a square knot is: Here are four tips to have fewer air knots and better knots in general. Plus, you won’t need to be placing additional sutures that increase the risk of pain and injury or spending time looking back through pedicles to find the one that’s bleeding. So better knots in general (as evidenced by fewer air knots in particular) can improve your surgical outcomes overall. They are sign of looser knots in general, and looser knots are more prone to delayed bleeding and knot failure, resulting sometimes in catastrophes like fascial dehiscence or even evisceration. Air knots can cause major complications, particularly bleeding. Ever get an air knot? I bet you do, especially if you are a resident or early in surgical training.
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