Running sutures anchored with square knots are unreliable

Aanning, H L; Osdol, Andrew Van; Allamargot, Chantal; B, Becker; Howard, Thomas C.; Likness, Micah L.; Merkwan, Courtney E.; Tarver, D

doi:10.1016/j.amjsurg.2011.09.029

Cited by 4 publications

(3 citation statements)

References 6 publications

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“…However, recent studies on monofilament sutures have demonstrated that flat knots assume a sliding conformation when held under unequal tension [21]. This in turn generates stress on the suture, which breaks precisely at the point at which the configuration of the knot changes [22,23]. Using a sliding knot on monofilament suture materials avoid the risk of changes in knot configuration, thus increasing ligature safety.…”

Section: Discussionmentioning

confidence: 99%

Ex vivo comparison of the giant and transfixing knot in equine open and closed castration

Comino

Giusto

Caramello

et al. 2016

Equine Veterinary Journal

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The giant and transfixing knot techniques have comparable haemostatic capability and parietal tunic tensile strength, but the giant knot requires less suture material. In open castration, using the emasculator alone may produce adequate haemostasis. In closed castration, using the giant knot in combination with the emasculator increases the bursting pressure and possibly reduces the incidence of haemorrhage. In closed castration, application of a ligature may reduce the risk of evisceration.

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Section: Discussionmentioning

confidence: 99%

Ex vivo comparison of the giant and transfixing knot in equine open and closed castration

Comino

Giusto

Caramello

et al. 2016

Equine Veterinary Journal

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“…The reliability and security of knots have been repeatedly shown to affect the geometry and tensile strength of sutures ( 31 ). Aanning and colleagues found that Prolene® sutures anchored with square knots retained only 75% of their strength compared with half hitches ( 32 ), while running 3–0 monofilament and multifilament sutures anchored with square knots retained only 50% to 84% of the strength of identical sutures secured with half hitches ( 33 ). These findings show the impact of knot types on suture security and suggest that running polypropylene suture anchored with half hitches is stronger and safer than the same suture secured with square knots.…”

Section: Discussionmentioning

confidence: 99%

BioGlue® is not associated with polypropylene suture breakage after aortic surgery

Pacini

Murana

Hollinworth³

et al. 2022

Front. Surg.

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ObjectiveWe have encountered broken or damaged polypropylene sutures (Prolene®) at the anastomotic sites during aortic reoperations. Because a surgical sealant, bovine serum albumin-glutaraldehyde (BioGlue®), was used in previous aortic surgery in some of these cases, we undertook this in vitro study to evaluate whether the use of BioGlue® was associated with breakage of polypropylene sutures at the aortic anastomosis.Materials and methodsThe broken polypropylene sutures, anastomotic sites and aortic tissue at the location of suture breakage were visually inspected and evaluated intraoperatively. Six human cadaveric aortic samples were incised circumferentially and anastomosed proximally to a valved conduit with running 4–0 polypropylene sutures (Prolene®). In the test group (n = 3), BioGlue® was applied directly to the Prolene® sutures at the anastomotic sites, while in the control group (n = 3) the anastomoses were not sealed with any surgical adhesive. The six samples were immersed in Dulbecco's phosphate buffered saline solution and mounted on a M-6 Six Position Heart Valve Durability Testing System and tested up to 120 million cycles for a 2-year period. During and upon completion of the testing, the integrity of Prolene® sutures, the anastomosis and aortic tissues was regularly assessed by visual inspection.ResultsIntraoperative findings included a stretched and thin aortic wall (some with thrombus), a small cleft between the aortic tissue and the Dacron vascular graft. An excessive amount of BioGlue® was often found around the anastomosis, with cracking material, but no signs of mechanical damage were observed in these cases. Upon visual inspection during and after in vitro testing, there was no apparent damage to the polypropylene sutures on the interior or exterior of the aortic anastomoses in any of the samples. No difference was observed in the physical integrity of the polypropylene sutures at anastomotic lines, the anastomoses and aortic tissues between the test and control samples.ConclusionsThe results of this study suggest that the use of BioGlue® was not associated with breakage of the polypropylene sutures at the anastomotic sites after aortic dissection repair.

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“…Recent studies on several knot types using monofilament suture material demonstrated that under tension the square knot changes its conformation into a sliding knot [ 19 ]. This alteration generates stress on the thread that breaks precisely at the point where knot’s configuration mutates [ 20 , 21 ]. Thus it is probably more advantageous with a monofilament suture material to perform a sliding knot from the beginning since its vessel sealing properties are equal to or better than a transfixing ligature performed using a surgeon’s knot.…”

Section: Discussionmentioning

confidence: 99%

Parallel alternating sliding knots are effective for ligation of mesenteric arteries during resection and anastomosis of the equine jejunum

et al. 2014

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BackgroundIn literature only one article describes and compares methods of achieving hemostasis in equine mesenteric arteries during jejunal resection and anastomosis, and most textbooks favor ligating-dividing mechanical devices. The latter method cannot always be used, not least because the devices are expensive and in some cases even contra-indicated. Various types of knots, including sliding knots, are widely used to provide hemostasis in laparoscopy.The objective of this study was to compare a triple ligature for mesenteric vessels composed of three sliding knots with a triple ligature composed of a modified transfixing and two surgeon’s knots.MethodsPortions of jejunum with associated mesenteric vessels were collected from 12 horses at a local abattoir. These were divided into 24 specimens containing five mesenteric arteries each. Each artery was closed with a triple ligature. In group A, a surgeon’s knot was used to tie the ligatures (two circumferential and one modified transfixing) while in group B all ligatures (three circumferential) were tied with a parallel alternating sliding knot. Both groups were divided ino two subgroups depending on suture material used (multifilament or monofilament suture material). Time to perform ligatures for every specimen were recorded and compared between groups.After closure, arteries were cannulated and intraluminal pressures were increased until ligature failure. Leaking pressures were recorded and compared between groups.ResultsLigation of mesenteric arteries was significantly faster to perform with sliding knots than with surgeon’s knots, both with monofilament and multifilament suture material. With multifilament suture material, the leaking pressure of sliding knot ligatures was significantly higher than that of surgeon’s knot ligatures. With monofilament suture, there were no statistically significant differences in leaking pressure between ligature methods. Both ligating methods were stronger with monofilament suture material than with multifilament suture material.ConclusionsRegardless of the ligature used, monofilament suture material performed better than multifilament suture material to achieve hemostatic knots. Independently of the suture material, the sliding knot is comparable or better than the surgeon’s knot in providing hemostasis, and is faster to perform.

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Running sutures anchored with square knots are unreliable

Cited by 4 publications

References 6 publications

Ex vivo comparison of the giant and transfixing knot in equine open and closed castration

Ex vivo comparison of the giant and transfixing knot in equine open and closed castration

BioGlue® is not associated with polypropylene suture breakage after aortic surgery

Parallel alternating sliding knots are effective for ligation of mesenteric arteries during resection and anastomosis of the equine jejunum

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