Effect of Diameter and Type of Suture on Knot and Loop Security

Author:

Romeo Armando1ORCID,Fujimoto Christiane2,Cipullo Isabella3ORCID,Giarola Mauricio4,Benedetto Chiara3,Kondo William5,Amro Bedayah6ORCID,Ussia Anastasia7ORCID,Wattiez Arnaud68ORCID,Koninckx Philippe R.691011ORCID

Affiliation:

1. Research Educational Center, University of Turin, 10124 Turin, Italy

2. Department of OBGYN, Faculty of Medicine, University of Santa Casa di Sao Paulo, Sao Paulo 05508-220, Brazil

3. Department Obstetrics and Gynecology, Ospedale Regina Montis Regalis di Mondovìn, 12084 Turin, Italy

4. Department of OBGYN, Faculty of Medicine, S.Anna Hospital Torino, 10126 Turin, Italy

5. Centro Avançado de Cirurgia Ginecológica, Department of OBGYN, Faculty of Medicine, Curitiba 81020-430, Brazil

6. Department of OBGYN, Faculty of Medicine, Latifa Hospital, Dubai 9115, United Arab Emirates

7. Department of OBGYN, Faculty of Medicine, Ucatholic University and Gruppo Italo Belga, Villa Del Rosario, 00168 Rome, Italy

8. Department of OBGYN, Faculty of Medicine, University of Strasbourg, 67081 Strasbourg, France

9. Department of OBGYN, Faculty of Medicine, Katholieke University Leuven, 3000 Leuven, Belgium

10. Department of OBGYN, Faculty of Medicine, University of Oxford, Oxford OX1 2JD, UK

11. Department of OBGYN, Faculty of Medicine, University Cattolica, del Sacro Cuore, 00168 Rome, Italy

Abstract

The loop and knot securities of two polyfilament and two monofilament sutures of four diameters (3.0, 2.0, 0, 1) were evaluated with a tensiometer for four four-throw knots, known to be secure with a 2.0 polyfilament suture. Loop security of Monocryl 1 is low, being 14.7 ± 3.0 Newton (N) for a three-throw half-knot (H3) and 15.4 ± 2.4 N and 28.3 ± 10 N for two (SSs) and four (SSsSsSs) symmetrical sliding half-hitches. This is lower than 18, 24, and 46 N for similar knots with Vicryl. Polyfilament sutures have excellent knot security for all four diameters. Occasionally, some slide open with slightly lower knot security, especially for larger diameters, although this is not clinically problematic. Knot security of monofilament sutures was unpredictable for all four knots, especially for larger diameters, resulting in many clinically insecure knots. A secure monofilament knot requires a six-throw knot with two symmetrical sliding half-hitches or two symmetrical half-knots secured with four asymmetric blocking half-hitches. In conclusion, with polyfilament sutures, four- or five-throw half-knot or half-hitch sequences result in secure knots. For monofilament sutures, loop and knot security is much less, half-knot combinations should be avoided, and secure knots require six-throw knots with four asymmetric blocking half-hitches.

Publisher

MDPI AG

Subject

General Medicine

Reference17 articles.

1. Mechanical performance of surgical sutures;Thacker;Am. J. Surg.,1975

2. Mechanical knot performance of a new generation polydioxanon suture (PDS-2);Trimbos;Acta Obstet. Gynecol. Scand.,1991

3. Performance of sliding knots in monofilament and multifilament suture material;Trimbos;Obstet. Gynecol.,1986

4. Security of various knots commonly used in surgical practice;Trimbos;Obstet. Gynecol.,1984

5. Tensile strengths of twelve types of knot employed in surgery, using different suture materials;Tera;Acta Chir. Scand.,1976

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