In vitro evaluation of the modified forwarder knot used to end a continuous suture pattern in large-gauge suture.

OBJECTIVE To evaluate the strength and size of forwarder end (FE) knots modified to end continuous suture lines compared with Aberdeen (AB), square (SQ), and surgeon's (SU) knots. STUDY DESIGN In vitro mechanical study. STUDY POPULATION Knotted suture. METHODS Knots were tied with 2 USP (United States Pharmacopeia) polydioxanone, 2 USP, and 3 USP polyglactin 910 and tested on a universal testing machine under linear tension. Mode of failure and knot holding capacity (KHC) were recorded, and relative knot security (RKS) was calculated. Knot volume and weight were determined by digital micrometer and balance. Knot holding capacity, RKS, size, and weight between knot type, number of throws, and suture type and size were compared by using analysis of variance testing, with P < .05 considered significant. RESULTS In all suture types and number of throws, FE knot KHC/RKS was 28% to 66.99% (1.2-1.6 fold) stronger compared with SQ/SU knots (P < .001). For 2 USP polydioxanone, FE knots had 10% (1.1 fold) higher KHC/RKS compared with AB knots (P < .042). However, in 2 and 3 USP polyglactin 910, FE knot KHC/RKS values were not different from those of AB knots (P > .080). Forwarder end/AB knots failed by suture breakage at the knot, whereas some SQ/SU knots unraveled. Forwarder end knots in 2 and 3 USP polyglactin 910 were 21.1% to 44.4% (1.2-1.4 fold) smaller compared with SQ/SU knots (P < .028). Forwarder end knots in 2 and 3 USP polyglactin 910 were 40% to 99% (1.4-2.0 fold) larger compared with AB knots (P < .001). CONCLUSION Forwarder end knots provided increased KHC/RKS compared with SQ/SU knots. CLINICAL RELEVANCE Forwarder end knots should be considered for closures when suture is placed under tension.

[1]  A. Munsterman,et al.  In vitro evaluation of square and surgeon's knots in large gauge suture , 2017, Veterinary surgery : VS.

[2]  A. Munsterman,et al.  Effect of fluid media on the mechanical properties of continuous pattern‐ending surgeon's, square, and Aberdeen knots in vitro* , 2017, Veterinary surgery : VS.

[3]  A. Munsterman,et al.  In Vitro Evaluation of the Aberdeen Knot for Continuous Suture Patterns with Large Gauge Suture. , 2016, Veterinary surgery : VS.

[4]  A. Munsterman,et al.  In Vitro Evaluation of the Size, Knot Holding Capacity, and Knot Security of the Forwarder Knot Compared to Square and Surgeon's Knots Using Large Gauge Suture. , 2016, Veterinary surgery : VS.

[5]  K. Mcgilvray,et al.  Comparison of volume, security, and biomechanical strength of square and Aberdeen termination knots tied with 4-0 polyglyconate and used for termination of intradermal closures in canine cadavers. , 2015, Journal of the American Veterinary Medical Association.

[6]  S. Hendrick,et al.  Ex vivo comparison of 7 polydioxanone, 2 polyglactin 910 for closure of ventral median celiotomy in horses. , 2013, Veterinary surgery : VS.

[7]  Bhupender S. Gupta,et al.  Biotextiles as medical implants , 2013 .

[8]  C. Chu.  Types and properties of surgical sutures , 2013 .

[9]  J. Kümmerle.  Chapter 16 – Suture Materials and Patterns , 2012 .

[10]  R. Day,et al.  In vitro comparison of secure Aberdeen and square knots with plasma- and fat-coated polydioxanone. , 2010, Veterinary surgery : VS.

[11]  L. Ripley,et al.  The ultimate Aberdeen knot. , 2007, Annals of the Royal College of Surgeons of England.

[12]  David G. Wilson,et al.  An in vitro biomechanical comparison of the breaking strength and stiffness of polydioxanone (sizes 2, 7) and polyglactin 910 (sizes 3, 6) in the equine linea alba. , 2005, Veterinary surgery : VS.

[13]  D. Freeman,et al.  Abdominal closure and complications , 2002 .

[14]  S S Burkhart,et al.  Knot security in simple sliding knots and its relationship to rotator cuff repair: how secure must the knot be? , 2000, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[15]  L. Galuppo,et al.  Comparison of incisional bursting strength of simple continuous and inverted cruciate suture patterns in the equine linea alba. , 1999, Veterinary surgery : VS.

[16]  J. Niles,et al.  Suture materials and patterns , 1999, In Practice.

[17]  S S Burkhart,et al.  Loop security as a determinant of tissue fixation security. , 1998, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[18]  D. Wilson,et al.  Complications of celiotomy incisions in horses. , 1995, Veterinary surgery : VS.

[19]  M. Markel,et al.  A study of the biomechanical properties of the adult equine linea alba: relationship of tissue bite size and suture material to breaking strength. , 1994, Veterinary surgery : VS.

[20]  G. Robinson,et al.  Knot security of suture materials. , 1989, Veterinary surgery : VS.

[21]  J. V. von Fraunhofer,et al.  Tensile properties of suture materials. , 1988, Biomaterials.