Minimum Number of Throws Needed for Knot Security

Muffly, Tyler M.; Kow, Nathan; Iqbal, Imran; Barber, Matthew D.

doi:10.1016/j.jsurg.2010.11.001

Cited by 44 publications

(43 citation statements)

References 2 publications

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“…5 In the present study, the number of throws (n = 5) applied to each knot was standardized in accordance with recommendations for continuous suture patterns given the type of suture material used provided in other studies. 12,13 Generally, the knots for most interrupted skin sutures are nonabsorbable and consist of only 3 to 4 throws. 14 The fact that all knots in the present study consisted of 5 throws might have inflated the time required to place the interrupted and cruciate patterns, compared with that typically required in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Comparison of tensile strength among simple interrupted, cruciate, intradermal, and subdermal suture patterns for incision closure in ex vivo canine skin specimens

Zellner¹,

Hedlund²,

Kraus³

et al. 2016

javma

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OBJECTIVE To compare suture placement time, tension at skin separation and suture line failure, and mode of failure among 4 suture patterns. DESIGN Randomized trial. SAMPLE 60 skin specimens from the pelvic limbs of 30 purpose-bred Beagles. PROCEDURES Skin specimens were harvested within 2 hours after euthanasia and tested within 6 hours after harvest. An 8-cm incision was made in each specimen and sutured with 1 of 4 randomly assigned suture patterns (simple interrupted, cruciate, intradermal, or subdermal). Suture placement time and percentage of skin apposition were evaluated. Specimens were mounted in a calibrated material testing machine and distracted until suture line failure. Tensile strength at skin-edge separation and suture-line failure and mode of failure were compared among the 4 patterns. RESULTS Mean suture placement time for the cruciate pattern was significantly less than that for other patterns. Percentage of skin apposition did not differ among the 4 patterns. Mean tensile strength at skin-edge separation and suture-line failure for the simple interrupted and cruciate patterns were significantly higher than those for the intradermal and subdermal patterns. Mean tensile strength at skin-edge separation and suture-line failure did not differ significantly between the intradermal and subdermal patterns or the simple interrupted and cruciate patterns. The primary mode of failure for the simple interrupted pattern was suture breakage, whereas that for the cruciate, intradermal, and subdermal patterns was tissue failure. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested external skin sutures may be preferred for closure of incisions under tension to reduce risk of dehiscence.

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Section: Discussionmentioning

confidence: 99%

Comparison of tensile strength among simple interrupted, cruciate, intradermal, and subdermal suture patterns for incision closure in ex vivo canine skin specimens

Zellner¹,

Hedlund²,

Kraus³

et al. 2016

javma

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show abstract

“…We believe a proper ratio of fineness of shell and core strands may increase knot-pull tensile strength of a knot, by balancing the bending damage of shell strands and extension of a core strand. Although more bends existed on surgeon's knot, its knot-pull tensile strength was not affected to the same extent as the three other knotting methods because of the friction between the first two overhand throws and the tight fit of filaments (Muffly et al, 2010(Muffly et al, , 2011. This result suggested that tying more throws is unnecessary when flat square knot is used because minimum bulk of knot was preferred as long as the strength satisfied the clinical requirement.…”

Section: Discussionmentioning

confidence: 95%

Quantitative physical and handling characteristics of novel antibacterial braided silk suture materials

Chen

Hou

Tang

et al. 2015

Journal of the Mechanical Behavior of Biomedical Materials

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“…Specimens were divided into two groups of 12 specimens each: in Group A, each mesenteric artery was ligated with three ligatures consisting of a circumferential ligature [1] proximally, followed by a transfixing ligature on the vascular bundle (mesenteric artery and vein) and a further circumferential ligature distally [2]; all ligatures were closed with a surgeon’s knot with four overthrows for a total of six throws [11]. In Group B, each artery was ligated with three circumferential ligatures tied with a sliding knot with two overthrows.…”

Section: Methodsmentioning

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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Minimum Number of Throws Needed for Knot Security

Cited by 44 publications

References 2 publications

Comparison of tensile strength among simple interrupted, cruciate, intradermal, and subdermal suture patterns for incision closure in ex vivo canine skin specimens

Comparison of tensile strength among simple interrupted, cruciate, intradermal, and subdermal suture patterns for incision closure in ex vivo canine skin specimens

Quantitative physical and handling characteristics of novel antibacterial braided silk suture materials

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

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