SDN Members don't see this ad. (About Ads) I've taught myself one and two hand ties with various surgery books but have noticed in the OR that none of the attendings or residents follow the way the books demonstrate. Specifically, no one ever crosses their hands with two hand ties or alternates their throws with one hand ties. Are these "non-textbook" ways of tying acceptable? Also, any advice on how to avoid throwing "air knots", especially with deep and tight structures?