The strength of suture knots after one week in vivo

Abstract

The strength of knotted thread for 12 different types of suture knot in combination with 11 types of suture material used in surgery was investigated one week after insertion in subcutaneous tissue in rabbits. The results were compared with similar investigations on knot strength carried out with 'dry knots'. The thread dimension used in both experiments was 000 (USP). As in vitro, the weakest point of a suture loop subjected to traction was the knot. The incidence of thread rupture within the loop but outside the knot was 1.4% in vitro and 5.9% in vivo, and was commonest with plain catgut. With one exception, however, thread breakage occurred at greater strain than the average required to produce knot failure with the material in question. A greater proportion of knots slipped in vivo then in vitro (72% and 35% respectively), with reduction of the strength of the suture loop as result. There was also greater scatter of measured values under in vivo conditions (standard deviation: 11% in vitro, 23% in vivo). For 7 of 11 suture materials the results indicated a reduction in knot-holding power after one week in situ in the living animal compared with in vivo conditions. This was naturally enough most marked with the two types of catgut (chrome 48%, plain 57%). In contrast, Dexon apparently remained unchanged after one week in vivo. The non-absorbable materials tested showed an estimated average fall in knot-holding power from 100% to 88% (range 109-65%), viz, an average of 12% units. The loss of holding power in vivo was, however, apparently never greater than 1/3 compared with 'dry knots' and calculated on average for all types of knot with non-absorbable materials.