Factors relating to the volume of surgical knots

Abstract

The suture's knot site represents the highest amount and density of foreign body material of a knotted suture loop. The volume of a knot is directly related to the total amount of inflammatory reaction surrounding the knot. We measured the volume of seven surgical knots frequently used in surgical practice. Two different suture materials and two different sizes were tested. Suture size was found to contribute significantly more to the volume of all knots tested than the number of throws of which the knots were composed. Knots made with coated multifilament polyglactin-910 were significantly larger than the knots made with monofilament nylon. Clinical implications of these findings are discussed. Surgical techniques keeping the volume of knots to a possible minimum, are encouraged.

A Semiquantitative Rat Model for Intraperitoneal Postoperative Adhesion Formation

“…In addition to being the highest amount and density of foreign body material of the suture loop [ 13,14], the suture knots were macroscopically seen taking part in a high percentage of the total adhesion formation, according to studies by other authors [14]. The zone surrounding the suture knot was thus pre sumed to be the most representative part to study the inflammatory reaction and the adhesion formation sur rounding suture material.…”

“…The sections were stained with toluidine blue. Tissue reaction was studied around the suture knots since the knot represents the highest amount and density of foreign body material of a knotted suture loop [13,14], Blood Loss. Blood loss was quantitated subjectively by grading the amount of blood loss after the excision of the peritoneal defect into none, mild, moderate, severe or heavily (0-5) as well as by grad ing the blood clots that had assembled in the abdominal cavity.…”

Variability of surgical knot tying techniques: do we need to standardize?

“…As the results reported in the literature are not standardized and not easily comparable [28], the technique options presented tend to confuse rather than help the surgical community [29,30]. This might be one of the reasons why some authors doubt that scientific evidence could persuade surgeons to change their technique [5]. However, it is interesting to know that if there would be one preferred knot tying technique, there are already randomized trials and even systematic reviews available describing how to teach this particular technique in a way to have the optimal learning success [4,[31][32][33].…”

“…The most common types of knots are square and sliding knots [5,6] with, however, many adaptations and modifications and different terminologies [1,[7][8][9][10][11][12][13][14][15]. Taken into account all possible variations, including one-handed, two-handed, and instrument knot tying techniques, it seems that surgeons have almost limitless options [14].…”

Evaluation of the tissue reaction of five different suture materials in rabbit palatal mucosa

“…Exudative foreign body reactions to sutures may give rise to inflammatory responses, decrease resistance to infection, and ultimately impair wound healing. 17 Sutures may also serve as a pathway for bacteria into a surgical wound, a physical process likely enhanced by the capillary action of the suture material. 18 The physical configuration of some suture materials may protect contaminating bacteria and enable microorganisms to multiply beyond the access of the body's defense system 19 .…”