Knot holding capacity of sliding knots under dry and in vivo conditions

Babetty, Zeina; Sümer, Aykut; Altıntaş, Sabri; Ergüney, Sabri

doi:10.1109/ibed.1998.710603

Cited by 2 publications

(2 citation statements)

References 6 publications

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“…33 Babetty et al compared four types of S knots in dry and in vivo conditions using silk and nylon (Table 3). 32 Parallel alternating sliding (S//S// S//S) was the only configuration unreliable in both conditions. Comparing S knots by material and gauge, parallel alternating sliding knots with different patterns (S//S = S//S) was superior in silk across gauges and conditions.…”

Section: Plasticitymentioning

confidence: 94%

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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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Section: Plasticitymentioning

confidence: 94%

“…6 Other in vivo factors that affected knot security include tissue holding power and dispersion of forces across the wound. 32 If tied too tightly, the tissues are strangulated, knot security reduced, and wound healing is impaired. In vivo, SQ knots also frequently take on a sliding conformation, particularly in monofilament sutures.…”

Section: In Vivo Conditionsmentioning

confidence: 99%

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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Biomechanics of surgical knot security: a systematic review

Wong

McGrouther

2023

International Journal of Surgery

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Background: This review aims to identify publications on quantitative biomechanical testing of surgical knot security and the physical factors that determine knot security and failure. Materials and Methods: An electronic literature search was performed in accordance with PRISMA guidelines in January 2022 utilizing the PubMed and Google Scholar databases to look for objective biomechanical studies on knot security in surgery using the primary terms ‘knot security’ and ‘biomechanical testing’. Results: Thirty-six articles were included. Twenty-four configurations of surface, laparoscopic, and arthroscopic knots were studied. Biomechanical tensile testing was used to evaluate knot security in vitro. Load to failure (N) and elongation at knot failure (mm) were quantified by static and cyclic testing to evaluate the knot holding capacity and failure mechanism of slippage or rupture. Conclusion: This review reassures that the knot configuration, suture materials, suture sizes, and number of throws are key factors in determining the knot’s security. Knot configuration has to be simple for laparoscopic and arthroscopic knots due to the confined space of the operating site. With the advent of stronger suture materials for high-tension surgical reconstructive procedures, there is an unmet need to understand the physical behavior of the knot and the factors that determine its resistance to slippage or rupture. Level of Evidence: Level IV.

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Knot holding capacity of sliding knots under dry and in vivo conditions

Cited by 2 publications

References 6 publications

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

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

Biomechanics of surgical knot security: a systematic review

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