Mechanical performance of square knots and sliding knots in surgery: A comparative study

Rijssel, E. J. C. Van; Trimbos, J. B.; Booster, M. H.

doi:10.1016/0002-9378(90)90828-u

Cited by 74 publications

(69 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…6,7 Today, the square knot is used as the gold standard for freehand knot tying in surgery, as it is the most secure especially when there is risk of tearing through delicate tissue. 10 However, because of the flat nature of the square knot, it is difficult to reproduce during surgery, as tension must be applied equally to both ends of the strand perpendicular to the axis of the knot. This is especially the case when tying a square knot within the limited space of a deep body cavity, where throws inadvertently not laid parallel to one another, often owing to greater tension applied to one strand of the suture, can create a slipknot.…”

Section: Discussionmentioning

confidence: 99%

“…This is especially the case when tying a square knot within the limited space of a deep body cavity, where throws inadvertently not laid parallel to one another, often owing to greater tension applied to one strand of the suture, can create a slipknot. 10 This is also known as the nonalternating post knot, which is generally weaker and has a greater chance of failure, as it is more prone to slippage. 1,2,10 The reversing half-hitch alternating post (RHAP) knot is an alternative to the square knot that addresses the issue of slippage seen in nonalternating post knots.…”

Section: Discussionmentioning

confidence: 99%

“…10 This is also known as the nonalternating post knot, which is generally weaker and has a greater chance of failure, as it is more prone to slippage. 1,2,10 The reversing half-hitch alternating post (RHAP) knot is an alternative to the square knot that addresses the issue of slippage seen in nonalternating post knots. The RHAP knot alternates posts with each successive throw to prevent the knot from sliding off of a single standing suture strand.…”

Section: Discussionmentioning

confidence: 99%

“…Knot failure by slippage was defined as 3 mm of loop elongation, and this criterion has been widely used in the evaluation of various suture and knot combinations. [1][2][3][4][5][8][9][10][13][14][15][16] One of us (V.W.) tied all knots to ensure consistency, as this was a commonly accepted method for knot construction across the literature on knot biomechanics.…”

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

Comparing the tensile strength of square and reversing half-hitch alternating post knots

Sykes

Mercer

et al. 2017

CJS

View full text Add to dashboard Cite

Background: Square knots are the gold standard in hand-tie wound closure, but are difficult to reproduce in deep cavities, inadvertently resulting in slipknots. The reversing half-hitch alternating post (RHAP) knot has been suggested as an alternative owing to its nonslip nature and reproducibility in limited spaces. We explored whether the RHAP knot is noninferior to the square knot by assessing tensile strength. Methods:We conducted 10 trials for each baseline and knot configuration, using 3-0 silk and 3-0 polyglactin 910 sutures. We compared tensile strength between knot configurations at the point of knot failure between slippage and breakage.Results: Maximal failure strength (mean ± SD) in square knots was reached with 4-throw in both silk (30 ± 1.5 N) and polyglactin 910 (39 ± 12 N). For RHAP knots, maximal failure strength was reached at 5-throw for both silk (31 ± 1.5 N) and polyglactin 910 (41 ± 13 N). In both sutures, there were no strength differences between 3-throw square and 4-throw RHAP, between 4-throw square and 5-throw RHAP, or between 5-throw square and 6-throw RHAP knots. Polyglactin 910 sutures, in all knot configurations, were more prone to slippage than silk sutures (p < 0.001).

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Comparing the tensile strength of square and reversing half-hitch alternating post knots

Sykes

Mercer

et al. 2017

CJS

View full text Add to dashboard Cite

show abstract

“…Inthisstudy,vanRijsseletal 5 concluded thattheoutcomeofthecomparisonofsquare and sliding knots depends on knot configuration, suture material, and suture size. Brown 6 examined 3 groups of knots to identify the most effective and efficient knotting techniques (square, surgeon's, and doublethrow knot).…”

mentioning

confidence: 99%

Changes in Knot-Holding Capacity of Sliding Knots In Vivo and Tissue Reaction

Babetty

Sümer²,

Altıntaş³

et al. 1998

Arch Surg

View full text Add to dashboard Cite

A Randomized Clinical Trial Comparing Two Methods of Fascia Closure Following Midline Laparotomy

Trimbos

Šmit²,

Holm³

et al. 1992

Arch Surg

View full text Add to dashboard Cite

Three hundred forty women undergoing midline laparotomy were randomized into an interrupted suture (polyglactin 910, size 1) or a continuous suture (polyglyconate, size 0) closure group. The two groups were well balanced with respect to various risk factors for postoperative wound complications. Early evaluation revealed no differences between the continuous and interrupted suture groups with respect to wound infection (3% vs 1%), superficial wound dehiscence (2% vs 4%), and deep wound dehiscence (0.6% vs 0%). Late evaluation showed no differences between the two groups either. Continuous polyglyconate and interrupted polyglactin 910 sutures had a similar incidence of suture fistula (0% vs 2%), wound pain (1% vs 2%), and incisional hernia (3% vs 4%). Continuous closure was done faster and resulted in less foreign-body suture material. Despite its smaller diameter, the polyglyconate suture also retains a higher tensile strength after surgery than does the quicker-degrading polyglactin 910 suture. Results of this study lead to the conclusion that a running polyglyconate suture is the better choice for closure of the abdominal-wall fascia following midline laparotomy.

show abstract

Mechanical performance of square knots and sliding knots in surgery: A comparative study

Cited by 74 publications

References 5 publications

Comparing the tensile strength of square and reversing half-hitch alternating post knots

Comparing the tensile strength of square and reversing half-hitch alternating post knots

Changes in Knot-Holding Capacity of Sliding Knots In Vivo and Tissue Reaction

A Randomized Clinical Trial Comparing Two Methods of Fascia Closure Following Midline Laparotomy

Contact Info

Product

Resources

About