The Miller׳s knot as an alternative to the surgical knotting? Characterization of the mechanical behavior

Ortillés, Ángel; Rodríguez, José Cruz Carrillo; Calvo, Begoña

doi:10.1016/j.jmbbm.2014.07.001

Cited by 6 publications

(3 citation statements)

References 19 publications

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“…In the last years, several studies have been carried out about the materials and technique of tie (Gil et al, 2012;Ortillés et al, 2014, von Trotha et al, 2017. The Kessler type suture (Gil Santos, 1993;Kessler, 1973;Moriya et al, 2010) and its modifications have been the most frequently used in repairing flexor tendons in the hand.…”

Section: Introductionmentioning

confidence: 99%

Positioning of the cross-stitch on the modified Kessler core tendon suture

Gil-Santos

Pradas

Gomar-Sancho

et al. 2018

Journal of the Mechanical Behavior of Biomedical Materials

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Cryopreserved human tendons were sutured with different variations of a modified Kessler-type grasping suture in a series of different designs in order to assess the influence of the distance between the cross-stitch on the core suture (5 and 10 mm from the cut tendon edge) on the peripheral suture. An original mathematical model was employed to explain the mechanical behavior (strength, deformation, and distribution of load) of the different suture designs. The effect of the peripheral epitendinous suture, combined with the distance of the core suture, was evaluated. The variation of core suture distance had no relevant consequences on the overall resilience of the design. However, increasing the distance between the cross-stitches of the core suture reduces the deformation that is absorbed not only by the core suture itself but also by the peripheral suture. Adding a peripheral epitendinous suture to a 10-mm design almost doubles the breaking load in absolute values. The mathematical model predicts that the peripheral suture will support a greater load when the distance of the core suture cross-stitches is increased. The evidence level is II.

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Section: Introductionmentioning

confidence: 99%

Positioning of the cross-stitch on the modified Kessler core tendon suture

Gil-Santos

Pradas

Gomar-Sancho

et al. 2018

Journal of the Mechanical Behavior of Biomedical Materials

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“…This knot type configuration has also demonstrated greater strength, resistance to bursting, and reduced suture breakage near the knot. 24,25 The objectives of the current study were first to evaluate the utility of this novel prosthesis technique by comparing it to the standard 2-suture technique. Secondly, to assess the effects of both techniques on the rima glottidis area.…”

Section: Ajvrmentioning

confidence: 99%

A biomechanical comparison of a novel two-loop suture technique and two sutures for laryngoplasty in the horse

Wilson

Roquet

Tucker

et al. 2023

ajvr

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OBJECTIVES Evaluation of the strength of the novel suture technique by comparison with a 2-interrupted suture technique. SAMPLE 40 equine larynges. PROCEDURES 40 larynges were used; 16 laryngoplasties were performed using the currently accepted 2-suture technique and 16 using the novel suture technique. These specimens were subjected to a single cycle to failure. Eight specimens were used to compare the rima glottidis area achieved with 2 different techniques. RESULTS The mean force to failure, as well as the rima glottidis area of both constructs, were not significantly different. The cricoid width did not have a significant effect on the force to failure. CLINICAL RELEVANCE Our results suggest that both constructs are equally strong and can achieve a similar cross-sectional area of the rima glottidis. Laryngoplasty (“tie-back”) is currently the treatment of choice for horses with exercise intolerance due to recurrent laryngeal neuropathy. Failure to maintain the expected degree of arytenoid abduction post-surgery occurs in some horses. We believe this novel 2-loop pulley load-sharing suture technique can help achieve and, more importantly, maintain the desired degree of abduction during surgery.

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“…Cinch knots are still under active development to find the best balance between a less complicated knot, high loop security, and how to secure the knot afterwards. Also, the superiority of Millers knot [32,33] or constrictor knot [34] for sealing vessels so that they are leakproof will not be discussed.…”

Section: Loop Securitymentioning

confidence: 99%

Laparoscopic Surgery: A Systematic Review of Loop and Knot Security, Varying with the Suture and Sequences, Throws, Rotation and Destabilization of Half-Knots or Half-Hitches

Koninckx,

Ussia,

Wattiez

et al. 2023

JCM

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Surgical knots are sequences of half-knots (H) or half-hitches (S), defined by their number of throws, by an opposite or similar rotation compared with the previous one, and for half-hitches whether they are sliding (s) or blocking (b). Opposite rotation results in (more secure) symmetric (s) knots, similar rotation in asymmetric (a) knots, and changing the active and passive ends has the same effect as changing the rotation. Loop security is the force to keep tissue together after a first half-knot or sliding half-hitches. With polyfilament sutures, H2, H3, SSs, and SSsSsSs have a loop security of 10, 18, 28, and 48 Newton (N), respectively. With monofilament sutures, they are only 7, 16, 18, and 25 N. Since many knots can reorganize, the definition of knot security as the force at which the knot opens or the suture breaks should be replaced by the clinically more relevant percentage of clinically dangerous and insecure knots. Secure knots with polyfilament sutures require a minimum of four or five throws, but the risk of destabilization is high. With monofilament sutures, only two symmetric+4 asymmetric blocking half-hitches are secure. In conclusion, in gynecology and in open and laparoscopic surgery, half-hitch sequences are recommended because they are mandatory for monofilament sutures, adding flexibility for loop security with less risk of destabilization.

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The Miller׳s knot as an alternative to the surgical knotting? Characterization of the mechanical behavior

Cited by 6 publications

References 19 publications

Positioning of the cross-stitch on the modified Kessler core tendon suture

Positioning of the cross-stitch on the modified Kessler core tendon suture

A biomechanical comparison of a novel two-loop suture technique and two sutures for laryngoplasty in the horse

Laparoscopic Surgery: A Systematic Review of Loop and Knot Security, Varying with the Suture and Sequences, Throws, Rotation and Destabilization of Half-Knots or Half-Hitches

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