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Related Experiment Videos

Dynamic loading of surgical knots.

J E Brouwers1, H Oosting, D de Haas

  • 1Department of Surgical Research, Academic Hospital, University of Amsterdam, The Netherlands.

Surgery, Gynecology & Obstetrics
|December 1, 1991
PubMed
Summary
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This study evaluated seven knots and seven suture materials for tensile strength. The 1=1=1 knot showed superiority, while most sliding knots were weak and unsuitable for surgical use.

Area of Science:

  • Biomaterials Science
  • Surgical Technology
  • Mechanical Engineering

Background:

  • Numerous suture materials are available, but their mechanical properties, especially when combined with knots, are not fully understood.
  • Understanding knot security and tensile strength is crucial for effective surgical practice and patient outcomes.

Purpose of the Study:

  • To dynamically test the tensile strength of seven different knots in seven distinct suture materials.
  • To classify knots based on their failure mode (predominantly breaking or predominantly slipping).
  • To introduce and apply the Kaplan-Meier survival estimate for a more realistic analysis of knot performance.

Main Methods:

  • Seven knot types (square and sliding variations) were created using seven suture materials (plain catgut, Dexon, Maxon, PDS, Vicryl, Mersilene, Prolene).

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  • Dynamic tensile strength testing was performed on each knot-suture combination.
  • Knots were categorized as predominantly breaking (PB) or predominantly slipping (PS).
  • The Kaplan-Meier survival estimate was employed for statistical analysis.

    • Main Results:

    • Square knots demonstrated good mechanical properties but did not entirely prevent slippage.
    • Most sliding knots exhibited weakness.
    • The 1=1=1 knot proved superior in terms of tensile strength and security.
    • Predominantly slipping (PS) knots, including 1=1, 2=1, SxSxS, and S=S parallel S, were deemed unsuitable for monofilament or coated multifilament sutures in surgical settings.
    • The PB/PS classification provided a clear indication of knot holding capacity.

    Conclusions:

    • The 1=1=1 knot is a superior choice among the tested configurations.
    • Certain sliding knots and specific square knots are not recommended for surgical applications due to slippage and weakness.
    • The Kaplan-Meier survival estimate offers a more accurate and realistic assessment of knot performance compared to traditional methods.
    • This research provides valuable data for selecting appropriate suture materials and knotting techniques in surgery.