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 SS  Vol.2 No.4 , June 2011
Surgical Knot Strength in Continuous Wound Closures
Abstract: Background: Forces applied to knots used for interrupted vs. continuous closures are very different. We studied the knot strength and knot security of three knots when simulating a continuous wound closure: the square, the sliding, and a hybrid constructed using a surgeon’s square knot followed by a sliding knot. Mate-rials and Methods: Knot holding capacity (KHC) of single-strand 1-0 polypropylene was determined by slow distraction on a horizontal testing sled of the strand that would be used to complete a continuous (“running”) closure following placement of an anchoring knot with six throws. Distraction continued until failure of the knot defined as breakage or slippage of the knot. Results: The mean and standard deviation of KHC meas-ured in pounds was determined (n = 30 for each knot): standard square 8.94 +/– 1.04; sliding 10.72 +/– 1.35; and hybrid 10.95 +/– 1.10. For each knot the relative knot security [(KHC of the knot/Tensile strength of untied strand) x 100] was calculated: standard square 69.5%; sliding 83.4%; hybrid 85.2%. Significant dif-ferences (p < 0.0001) in KHC exist between square and sliding knots (favoring sliding knots) and between square and hybrid knots (favoring hybrid knots). Hybrid and sliding knots were not statistically different. Conclusion: Sliding knots and hybrid knots are superior to square knots as anchoring knots for single-strand continuous wound closure.
Cite this paper: nullA. Nigliazzo, R. Arrangoiz, R. Hutchison, M. Basson and A. Saxe, "Surgical Knot Strength in Continuous Wound Closures," Surgical Science, Vol. 2 No. 4, 2011, pp. 195-197. doi: 10.4236/ss.2011.24043.
References

[1]   Dinsmore RC. Understanding surgical knot security: a proposal to standardize the literature. J Am Coll Surg 1995; 180: 689-99.

[2]   Schaaf O, Glyde M, Day RE. In vitro comparison of secure Aberdeen and square knots with plasma- and fat-coated polydioxanone. Vet Surg 2010;39:553-60

[3]   Richey ML, Roe SC. Assessment of knot security in continuous intradermal wound closures. J Surg Res 2005; 123: 284-8.

[4]   Aanning HL, Haas T, Jorgensen DR, Corey WA. Square not a running knot. J Am Coll Surg 2007; 204: 422-5.

[5]   Gunderson PE. The half-hitch knot: a rational alternative to the square knot. Am J Surg 1987; 154: 538-40.

[6]   Fong ED, Bartlett ASR, Malak S, Anderson IA. Tensile strength of surgical knots in abdominal wall closure. ANZ J Surg 2008; 78: 164-6.

[7]   Trimbos JB, Van Rijssel EJ, Klopper PJ. Performance of sliding knots in monofilament and multifilament suture material. Obstet Gynecol 1986; 68: 425-30.

 
 
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