Depending on the size of the knife, you could do it for either a left hand or right hand horizontal draw, the difference will be whether the blade edge is up or down. On the sheath for the small knives, it has an "X" of leather for the belt loop allowing for either horizontal or vertical carry. If vertical, you could rotate the entire sheath to allow for left or right hand draw, or small of the back vs. side for instance. The knife will always be the same orientation in the sheath, but the sheath would rotate on the belt. Does that make sense?