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Comparative strength of ligature points achieved by various surgical knot-tying techniques: an observational study
Shoichi Tsuzaka1, Yuji Konishi2, Kazuhiro Mino1
1Department of Surgery, National Hospital Organization Hokkaido Medical Center, 1-1, 5-7, Yamanote, Nishi-Ku, Sapporo, Hokkaido, 063-0005, Japan.
Purpose:
Surgical knot-tying requires careful selection of the appropriate technique for optimal outcomes; however, evidence is lacking about the common ligation techniques combining square and slip knots (combination knots). This study investigates the strength of a combination knot, compared with other techniques.
Methods:
In this observational cohort study, we assessed the strengths of square, slip-granny, slip-reef, and combination knots using absorbable monofilament sutures, and compared them using ANOVA and a multilevel linear regression analysis. We also assessed the correlation between the number of throws and knot strength using Spearman's correlation analysis.
Results:
Among 80 ligatures, ANOVA indicated significant differences in knot strength among the techniques (p < 0.01). Multilevel linear regression showed that a combination knot was stronger than a slip knot (p < 0.01) and comparable to a square knot (p = 0.0721). Secondary analysis indicated that for combination knots, five throws could achieve sufficient knot strength.
Conclusion:
Combination knots are as strong as square knots and stronger than slip knots, and thus present a reasonable option for surgical ligation.
