In Vitro Evaluation of the Size, Knot Holding Capacity, and Knot Security of the Forwarder Knot Compared to Square and Surgeon's Knots Using Large Gauge Suture

Gillen, Alexandra; Munsterman, Amelia S.; Hanson, R. Reid

doi:10.1111/vsu.12556

Cited by 10 publications

(46 citation statements)

References 21 publications

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“…The use of the self‐locking knot combination increased incisional bursting strength by an average of 25%, without requiring additional time. Because the forwarder and Aberdeen knots have a smaller weight and volume compared with the surgeon's knot, this combination may also reduce the volume of foreign material within the closure of the linea alba …”

Section: Discussionmentioning

confidence: 99%

“…Such failure may reflect the creation of a stress point between the interface of the loop and the first throw due to the load applied to the surgeon's knot. In contrast, the intrinsic properties of self‐locking knots allow the suture to slide within the knot, dissipating the tension and reducing the coefficient of friction at the knot–suture interface . This property makes the self‐locking knot stronger than a traditional surgeon's knot, offering a more secure closure.…”

Section: Discussionmentioning

confidence: 99%

“…The surgeon's start knot was tied with 5 throws, and the surgeon's end knot was tied with 6 throws. The forwarder start knot was tied with 4 throws, and the Aberdeen end knot was tied with 3 throws and 1 turn (Figures ) . These throw combinations were extrapolated from data previously published by our laboratory that determined that these throw combinations displayed the highest knot holding capacity with the smallest knot size .…”

Section: Methodsmentioning

confidence: 99%

“…In ex vivo studies, closures performed with polyglactin 910 in a simple continuous suture pattern fail mainly at the surgeon's knot . According to in vitro tests, tied large gauge suture loops break at or adjacent to the knot 90%‐100% of the time . This mode of failure has been attributed to a deformation of the material's original structure due to the load, creating a stress point between the loop and the first throw of the knot .…”

Section: Introductionmentioning

confidence: 99%

“…12,13 According to in vitro tests, tied large gauge suture loops break at or adjacent to the knot 90%-100% of the time. 14,15,[17][18][19] This mode of failure has been attributed to a deformation of the material's original structure due to the load, creating a stress point between the loop and the first throw of the knot. 20 The addition of a knot to a suture line has also been found to decrease the tensile strength of that suture by 30%-35%.…”

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confidence: 99%

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Bursting strength of surgeon's and self‐locking knots for closure of ventral midline celiotomy in horses

et al. 2018

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Objective To compare the bursting strength and failure mode of ventral midline celiotomy closed with a simple continuous suture pattern with 1 of 2 knot combinations, a novel self‐locking knot combination of a forwarder start with an Aberdeen end knot (F‐A) and a traditional combination of a surgeon's start with a surgeon's end knot (S‐S). Study design Ex vivo experimental. Sample population Equine cadavers (n = 14). Methods A 20‐cm ventral midline celiotomy was created in 14 equine cadavers. Horses were assigned to celiotomy closure with an F‐A or S‐S knot combination. Prior to closure, a 200‐L inflatable bladder was placed in the abdomen and then insufflated until failure of the celiotomy closure. The horses’ signalment, weight, breed, and age, as well as knot combination type, mode of failure, closure time, and bursting strength (mm Hg) were recorded. Results The median bursting strength was significantly greater when incisions were closed with the F‐A knot combination (388 mm Hg) compared with the S‐S knot combination (290 mm Hg) (P = .035). Most incisions failed along the fascia when closed with F‐A combinations and at the knot when closed with S‐S combinations. Conclusion The bursting strength of ventral midline incisions in equine cadavers was increased by an average of 25% when closed with the self‐locking F‐A knot combination. Clinical significance Closing ventral midline celiotomies with an F‐A knot combination may provide a more secure closure than the traditional S‐S knot combination. Additional in vivo investigation is required prior to recommending this closure in clinical cases.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Bursting strength of surgeon's and self‐locking knots for closure of ventral midline celiotomy in horses

et al. 2018

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Suture Materials and Patterns

Kümmerle¹,

Fogle²,

Auer³

et al. 2019

Equine Surgery

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Knot Security 101: A Comprehensive Practical Review to Optimal Knot Configuration, Pulling Direction, Throw Count, and Tail Length

Bushong,

Janis

2024

Plastic and Reconstructive Surgery - Global Open

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Background: Knots are the weakest structural point in a suture line and inevitably weaken almost all suture materials. This practical review critically evaluates the factors, such as suture material properties, gauge, configuration, throw count, and tail length, that affect knot security. Methods: A PubMed search between the years 1934 and 2023 identified relevant studies that addressed factors relating to knot security. Studies that investigated knots and sutures solely used in laparoscopic and arthroscopic surgery were excluded. Knot configurations assessed were the Aberdeen, sliding, square, and surgeon’s. Results: Eighty-six articles were included in this review article and demonstrated that knot security varies greatly between suture materials and gauge. Knot security also varies by configuration, throw count, conditions, tail length, and stitch type. Throw count differs by knot configuration, with the Aberdeen knot being most secure with three throws and one to two turns compared with three to five throws for surgeon’s and square knots. The optimal tail length was 3 mm. Conclusions: This practical review demonstrates that there are significant differences in knot security based on a variety of factors. It is challenging to propose an ideal knot because most studies did not evaluate knot security using a broad variety of suture materials, gauges, and throws for each of the most common knots. Although this review article demonstrated several applicable findings, additional robust studies are needed to simplify proposals.

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In Vitro Evaluation of the Size, Knot Holding Capacity, and Knot Security of the Forwarder Knot Compared to Square and Surgeon's Knots Using Large Gauge Suture

Abstract: Forwarder knots may be an alternative for commencing continuous patterns in large gauge suture, without sacrificing knot integrity, but further in vivo and ex vivo testing is required to assess the effects of this sliding knot on tissue perfusion before clinical application.

Cited by 10 publications

References 21 publications

Bursting strength of surgeon's and self‐locking knots for closure of ventral midline celiotomy in horses

Bursting strength of surgeon's and self‐locking knots for closure of ventral midline celiotomy in horses

Suture Materials and Patterns

Knot Security 101: A Comprehensive Practical Review to Optimal Knot Configuration, Pulling Direction, Throw Count, and Tail Length

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