Tensile Strength in Vicryl Versus Prolene 5-0 Knots: Impact of Throw Type and Count

Surgical knot security is essential to preventing complications such as knot failure or tissue tearing. The number of throws and the use of surgeon's knots influence knot strength; thus, this study aimed to evaluate the impact of throws and surgeon's knots on the tensile strength and loop elongation of Vicryl and Prolene 5-0 sutures.

Vicryl and Prolene 5-0 sutures were tied in knots of 3, 4, and 5 throws, across 12 different knot sequences: single knots only, surgeon's knots only, and an increasing number of surgeon's knots. Samples were tested using a tensiometer applying a constant force until knot failure or slippage.

The tensile strength of the knots increased significantly with the number of throws and the presence of surgeon's knots (P < 0.005). Five-throw knots were stronger than 3-throw knots regardless of the number of surgeon's knots for both types of sutures. The use of surgeon's knots only significantly increased strength in the 3-throw series for both Prolene and Vicryl sutures. For both sutures, a 3-throw surgeon's knot showed the same tensile strength as a 5-throw simple knot. Loop elongation depended on the number of throws and surgeon's knots.

The use of surgeon's knots alone increased a knot's breaking resistance without the need for additional simple throws. A 3-throw surgeon's knot provides breaking resistance equivalent to a knot with more throws. If reduced loop elongation is desired, the choices would be 4 surgeon's throws for Vicryl and 5 simple throws for Prolene.