Effect of fluid media on the mechanical properties of continuous pattern-ending surgeon's, square, and Aberdeen knots in vitro

Abstract

Objective: To investigate the knot holding capacity (KHC) of pattern-ending square, surgeon's and Aberdeen knots each tied in 4 throw combinations using large gauge suture after exposure to media commonly found in equine abdominal surgery.

Study design: In vitro mechanical study.

Sample population: Knotted suture strands (n = 10/group).

Methods: Strands of 2 polydioxanone or 3 polyglactin 910 were exposed to 1 of 4 media for 15 minutes. Control suture strands remained dry. Media used included balanced electrolyte solution, 1% sodium carboxymethylcellulose, equine serum, or equine fat. Pattern-ending knots for the 3 knot configurations were loaded to failure in a linear fashion on a materials testing machine to determine KHC.

Results: Surgeon's knots tied using media-exposed 3 polyglactin 910 had a significantly higher KHC than the same dry knots with 5 and 6 throws. Square knots tied using media-exposed to 3 polyglactin 910 had a significantly higher KHC than the same dry knots at 5 throws. Aberdeen knots tied with either media-exposed 2 polydioxanone or 3 polyglactin 910 had a significantly higher KHC than their equivalent dry knots. Aberdeen knots had a superior KHC, while requiring less suture than both surgeon's and square knots.

Conclusion: Media exposure either had no effect on KHC or significantly improved the KHC of all knots investigated. Based on KHC and knot volume, Aberdeen knots tied using media-exposed 3 polyglactin 910 with 3 throws and 1 turn are recommended to end a continuous suture pattern.