All Monofilament Knots Assume Sliding Conformation In Vivo

Davis, Donald R.; Pellowski, Donna M.; Rawdon, Eric J.

doi:10.1111/dsu.12112

Cited by 11 publications

(9 citation statements)

References 6 publications

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“…Rijkhenuizen et al [7] recommend using a monofilament material and a transfixing knot as the ligation method of choice in castration. However, recent studies on monofilament sutures have demonstrated that flat knots assume a sliding conformation when held under unequal tension [21]. This in turn generates stress on the suture, which breaks precisely at the point at which the configuration of the knot changes [22,23].…”

Section: Discussionmentioning

confidence: 99%

Ex vivo comparison of the giant and transfixing knot in equine open and closed castration

Comino

Giusto

Caramello

et al. 2016

Equine Veterinary Journal

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The giant and transfixing knot techniques have comparable haemostatic capability and parietal tunic tensile strength, but the giant knot requires less suture material. In open castration, using the emasculator alone may produce adequate haemostasis. In closed castration, using the giant knot in combination with the emasculator increases the bursting pressure and possibly reduces the incidence of haemorrhage. In closed castration, application of a ligature may reduce the risk of evisceration.

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Section: Discussionmentioning

confidence: 99%

Ex vivo comparison of the giant and transfixing knot in equine open and closed castration

Comino

Giusto

Caramello

et al. 2016

Equine Veterinary Journal

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“…With the monofilament suture material, the two different ligating methods produced similar results and were more resistant to pressure than the surgeon’s knot technique performed with multifilament suture material. This difference is likely due to the elastic properties of the monofilament suture that give more grip to the stretched portion within the knots as previously described[ 19 ]. Recent studies on several knot types using monofilament suture material demonstrated that under tension the square knot changes its conformation into a sliding knot [ 19 ].…”

Section: Discussionmentioning

confidence: 95%

“…This difference is likely due to the elastic properties of the monofilament suture that give more grip to the stretched portion within the knots as previously described[19]. Recent studies on several knot types using monofilament suture material demonstrated that under tension the square knot changes its conformation into a sliding knot [19]. This alteration generates stress on the thread that breaks precisely at the point where knot’s configuration mutates [20,21].…”

Section: Discussionmentioning

confidence: 99%

Parallel alternating sliding knots are effective for ligation of mesenteric arteries during resection and anastomosis of the equine jejunum

et al. 2014

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BackgroundIn literature only one article describes and compares methods of achieving hemostasis in equine mesenteric arteries during jejunal resection and anastomosis, and most textbooks favor ligating-dividing mechanical devices. The latter method cannot always be used, not least because the devices are expensive and in some cases even contra-indicated. Various types of knots, including sliding knots, are widely used to provide hemostasis in laparoscopy.The objective of this study was to compare a triple ligature for mesenteric vessels composed of three sliding knots with a triple ligature composed of a modified transfixing and two surgeon’s knots.MethodsPortions of jejunum with associated mesenteric vessels were collected from 12 horses at a local abattoir. These were divided into 24 specimens containing five mesenteric arteries each. Each artery was closed with a triple ligature. In group A, a surgeon’s knot was used to tie the ligatures (two circumferential and one modified transfixing) while in group B all ligatures (three circumferential) were tied with a parallel alternating sliding knot. Both groups were divided ino two subgroups depending on suture material used (multifilament or monofilament suture material). Time to perform ligatures for every specimen were recorded and compared between groups.After closure, arteries were cannulated and intraluminal pressures were increased until ligature failure. Leaking pressures were recorded and compared between groups.ResultsLigation of mesenteric arteries was significantly faster to perform with sliding knots than with surgeon’s knots, both with monofilament and multifilament suture material. With multifilament suture material, the leaking pressure of sliding knot ligatures was significantly higher than that of surgeon’s knot ligatures. With monofilament suture, there were no statistically significant differences in leaking pressure between ligature methods. Both ligating methods were stronger with monofilament suture material than with multifilament suture material.ConclusionsRegardless of the ligature used, monofilament suture material performed better than multifilament suture material to achieve hemostatic knots. Independently of the suture material, the sliding knot is comparable or better than the surgeon’s knot in providing hemostasis, and is faster to perform.

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“…Hendrickson also reported that monofilament suture holds knots more securely than braided material. Flat knots created with monofilament suture assumed a sliding conformation when held under unequal tension in a recent study . This configuration change creates stress on the suture material, causing breakage within the knot .…”

Section: Discussionmentioning

confidence: 99%

“…Flat knots created with monofilament suture assumed a sliding conformation when held under unequal tension in a recent study . This configuration change creates stress on the suture material, causing breakage within the knot . Using a friction or sliding knot with monofilament suture avoids such a risk, thereby increasing security …”

Section: Discussionmentioning

confidence: 99%

Evaluation of three ligatures in simulated equine open castration

et al. 2020

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Objective: To compare three surgical knots for preventing leakage from the vascular bundle during ligation in simulated equine open castrations. Study design: Randomized, case-control, in vitro study. Sample population: Testes (N = 60) collected from 30 horses. Methods: Testes were collected from 30 horses and randomly assigned to one of three groups: group G (friction, giant knot), group T (modified transfixing knot), or group S (sliding, strangle knot; n = 20/group). The assigned knot was used to ligate the vascular bundle during open castration. The length of suture material used and the leak pressure of the testicular artery were measured and compared between groups. Results: Strangle knots consistently leaked at higher pressures (median, 735.5 mm Hg; interquartile range [IQR], 735.5-735.5) compared with giant (median, 441.3 mm Hg; IQR, 367.8-643.6) and transfixing (median, 419.2 mm Hg; IQR, 323.6-643.6; P < .0001) knots. Both the strangle (median, 5 cm; IQR, 4.5-5.5) and giant (median, 6 cm; IQR, 5.35-6.075) knots required less suture material compared with the transfixing (median, 9.2 cm; IQR, 8.425-10.38; P < .0001) knot. Conclusion: The three surgical knots tested withstood pressure well above physiological levels in simulated open castrations. The strangle knot withstood higher pressure and required similar (giant) or less (transfixing) suture material than the other two knots. Clinical significance: This study provides evidence to support the use of a strangle knot to ligate the vascular bundle during simulated open castrations in horses.

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All Monofilament Knots Assume Sliding Conformation In Vivo

Abstract: When monofilament suture is securely cinched in vivo, kinetic energy forces even a flat throw into sliding conformation. A well-crafted, intentionally sliding square knot appears compacter than any other monofilament knot.

Cited by 11 publications

References 6 publications

Ex vivo comparison of the giant and transfixing knot in equine open and closed castration

Ex vivo comparison of the giant and transfixing knot in equine open and closed castration

Parallel alternating sliding knots are effective for ligation of mesenteric arteries during resection and anastomosis of the equine jejunum

Evaluation of three ligatures in simulated equine open castration

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