Technical considerations in knot construction. Part I. Continuous percutaneous and dermal suture closure

Area of Science:

• Surgical techniques
• Materials science
• Biomedical engineering

Background:

• Surgical knots are critical for wound closure and device fixation.
• Understanding suture security is essential for preventing complications.
• The square knot is a fundamental surgical knot with variations in tying methods.

Purpose of the Study:

• To compare the security of square knots tied with one looped end versus two free ends.
• To evaluate the mechanical performance of different suture materials in square knots.
• To determine the optimal method for achieving secure surgical knots.

Main Methods:

• Utilized size 4/0 and 6/0 monofilament sutures (nylon, polypropylene, Biosyn).
• Tied square knots using two distinct methods: one looped end and one free end, versus two free ends.
• Assessed mechanical performance via knot breakage force and the number of throws needed for security.

Main Results:

• Square knots tied with one looped end and one free end required significantly more throws to achieve security.
• Suture material and size influenced knot security, but the tying method had a notable impact.
• Knots with one looped end demonstrated a trend towards higher breakage force, though not statistically significant across all conditions.

Conclusions:

• Tying square knots with one looped end and one free end enhances knot security by requiring more throws.
• This method may be preferable in situations demanding higher knot security, potentially reducing slippage.
• Further research should explore the clinical implications of these findings on surgical outcomes.