Abstract
To evaluate the strength and size of forwarder end (FE) knots modified to end continuous suture lines compared with Aberdeen (AB), square (SQ), and surgeon's (SU) knots. In vitro mechanical study. Knotted suture. Knots were tied with 2 USP (United States Pharmacopeia) polydioxanone, 2 USP, and 3 USP polyglactin 910 and tested on a universal testing machine under linear tension. Mode of failure and knot holding capacity (KHC) were recorded, and relative knot security (RKS) was calculated. Knot volume and weight were determined by digital micrometer and balance. Knot holding capacity, RKS, size, and weight between knot type, number of throws, and suture type and size were compared by using analysis of variance testing, with P < .05 considered significant. In all suture types and number of throws, FE knot KHC/RKS was 28% to 66.99% (1.2-1.6 fold) stronger compared with SQ/SU knots (P < .001). For 2 USP polydioxanone, FE knots had 10% (1.1 fold) higher KHC/RKS compared with AB knots (P < .042). However, in 2 and 3 USP polyglactin 910, FE knot KHC/RKS values were not different from those of AB knots (P > .080). Forwarder end/AB knots failed by suture breakage at the knot, whereas some SQ/SU knots unraveled. Forwarder end knots in 2 and 3 USP polyglactin 910 were 21.1% to 44.4% (1.2-1.4 fold) smaller compared with SQ/SU knots (P < .028). Forwarder end knots in 2 and 3 USP polyglactin 910 were 40% to 99% (1.4-2.0 fold) larger compared with AB knots (P < .001). Forwarder end knots provided increased KHC/RKS compared with SQ/SU knots. Forwarder end knots should be considered for closures when suture is placed under tension.
Highlights
Complete incisional dehiscence and subsequent eventration is a potentially fatal complication which can occur following ventral midline celiotomy
For 2 USP polydioxanone, forwarder end (FE) knots had 10% (1.1 fold) higher knot holding capacity (KHC)/relative knot security (RKS) compared with AB knots (P < .042)
Forwarder end knots in 2 and 3 USP polyglactin 910 were 40% to 99% (1.4‐2.0 fold) larger compared with AB knots (P < .001)
Summary
Complete incisional dehiscence and subsequent eventration is a potentially fatal complication which can occur following ventral midline celiotomy. Surgeons frequently choose to use a simple continuous suture pattern to close ventral median celiotomies, and this pattern has been shown to be stronger than the inverted cruciate pattern.[3] For a simple continuous suture pattern, the start and end knots are critical to ensure the security of the suture line. In studies in which the biomechanics of several suture types and sizes in the equine linea alba were examined, the cause of closure failure was most frequently due to knot failure, which occurred in 80%4, 90.4%5, and 93%6 of the specimens. The findings of these studies provide evidence of the importance of appropriate knot construction for security of the closure.
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