A granny sliding knot for high-tension closures

Scott, Jeffrey F.; Ascha, Mona; Pollard, Whitney; Bordeaux, Jeremy S.

doi:10.1016/j.jaad.2018.07.005

Cited by 5 publications

(5 citation statements)

References 2 publications

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“…Loop security or holding strength is the first aspect to consider when suturing [20]. This is the force needed to open the first loop, which can be the first half-knot, one or more sliding half-hitches, a sliding granny knot [21], or a cinch knot. Loop security keeps the tissues approximated or sutured arteries leakproof until additional half-knots or halfhitches are added, securing the knot.…”

Section: Testing and Definitions Of Loop And Knot Securitymentioning

confidence: 99%

“…(Figure 2). Although forces were not measured, the unstable granny knot (H1H1a) and H2H1a can be used to secure veins [28] or for wound closure [21].…”

Section: Loop Securitymentioning

confidence: 99%

“…(Figure 2). A forces were not measured, the unstable granny knot (H1H1a) and H2H1a can be secure veins [28] or for wound closure [21]. For monofilament sutures, such as polyglecaprone 2.0 (Monocryl), the loop is lower than for polyfilament sutures.…”

Section: Loop Securitymentioning

confidence: 99%

“…For polyfilament sutures, secure knots require five throws, whether percentage opening [4,8,41] or as the percentage insecure and dangerous k security, defined as breaking forces, obviously increases with suture diame security also improves with rotation, with symmetric knots made by alte being more secure [16]. For example, the asymmetric granny knots (H1H1a H2H1a [21] are so unstable that they can be considered sliding knots with Clinically, the (occasional) risk of insecure or dangerous knots is more important than the mean breaking force of a knot. This variability of knot security is caused by the reorganization of the knot sequences when forces are applied.…”

Section: Knot Securitymentioning

confidence: 99%

“…However, security also improves with rotation, with symmetric knots made by alternate rotation being more secure [16]. For example, the asymmetric granny knots (H1H1a) and even the H2H1a [21] are so unstable that they can be considered sliding knots with monofilament sutures. Secure half-knot sequences require four or five throws, and only H2H2 and H3H2 sequences are secure without insecure or dangerous knots.…”

Section: Knot Securitymentioning

confidence: 99%

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Laparoscopic Surgery: A Systematic Review of Loop and Knot Security, Varying with the Suture and Sequences, Throws, Rotation and Destabilization of Half-Knots or Half-Hitches

Koninckx,

Ussia,

Wattiez

et al. 2023

JCM

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Surgical knots are sequences of half-knots (H) or half-hitches (S), defined by their number of throws, by an opposite or similar rotation compared with the previous one, and for half-hitches whether they are sliding (s) or blocking (b). Opposite rotation results in (more secure) symmetric (s) knots, similar rotation in asymmetric (a) knots, and changing the active and passive ends has the same effect as changing the rotation. Loop security is the force to keep tissue together after a first half-knot or sliding half-hitches. With polyfilament sutures, H2, H3, SSs, and SSsSsSs have a loop security of 10, 18, 28, and 48 Newton (N), respectively. With monofilament sutures, they are only 7, 16, 18, and 25 N. Since many knots can reorganize, the definition of knot security as the force at which the knot opens or the suture breaks should be replaced by the clinically more relevant percentage of clinically dangerous and insecure knots. Secure knots with polyfilament sutures require a minimum of four or five throws, but the risk of destabilization is high. With monofilament sutures, only two symmetric+4 asymmetric blocking half-hitches are secure. In conclusion, in gynecology and in open and laparoscopic surgery, half-hitch sequences are recommended because they are mandatory for monofilament sutures, adding flexibility for loop security with less risk of destabilization.

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Section: Testing and Definitions Of Loop And Knot Securitymentioning

confidence: 99%

“…(Figure 2). Although forces were not measured, the unstable granny knot (H1H1a) and H2H1a can be used to secure veins [28] or for wound closure [21].…”

Section: Loop Securitymentioning

confidence: 99%