Knot Security of 5 Metric (USP 2) Sutures: Influence of Knotting Technique, Suture Material, and Incubation Time for 14 and 28 Days in Phosphate Buffered Saline and Inflamed Equine Peritoneal Fluid.
Authors: Sanders Ruth E, Kearney Clodagh M, Buckley Conor T, Jenner Florien, Brama Pieter A
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Knot Security in Equine Surgical Sutures Selecting appropriate suture materials and knotting techniques is fundamental to surgical success, yet the biomechanical behaviour of knots in the equine peritoneal environment—particularly under inflammatory conditions—remains poorly characterised. Sanders and colleagues evaluated knot security across three commonly used 5 metric absorbable sutures (polydioxanone, polyglactin 910, and glycolide/lactide copolymer) using three knot configurations (square, surgeon's, and triple knots), testing each to failure immediately after tying and following 14- and 28-day incubation in both physiological buffer solution and inflamed equine peritoneal fluid. Polydioxanone demonstrated significant differences between square and surgeon's knots, with the square knot proving inadequate; polyglactin 910 showed differences between square and triple knots; whilst glycolide/lactide copolymer exhibited superior knot security across all configurations. Notably, incubation in inflamed peritoneal fluid caused substantially greater and faster loss of knot strength than physiological conditions, suggesting that the inflammatory environment following colic surgery may compromise suture security more severely than previously recognised. These findings argue strongly against square knots in polydioxanone and indicate that glycolide/lactide copolymer offers more reliable knot security in the equine abdomen, potentially influencing material selection and technique standardisation in abdominal closure protocols.
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Practical Takeaways
- •Use surgeon's knots rather than square knots when working with polydioxanone sutures in abdominal closure, as square knots provide insufficient security.
- •Glycolide/lactide copolymer (polyglactin 910 equivalent materials) offer reliable knot holding regardless of technique—choice of knot type is less critical with this material.
- •In contaminated or inflamed abdominal environments, suture knot security degrades faster; consider this when selecting suture materials and knot types for peritoneal closure in septic cases.
Key Findings
- •Polydioxanone square knots are significantly weaker than surgeon's and triple knots, with no additional benefit of triple over surgeon's knots.
- •Glycolide/lactide copolymer demonstrated excellent knot security regardless of knotting technique.
- •Incubation in inflamed peritoneal fluid caused more rapid and greater loss of knot holding strength compared to physiological saline over 14-28 days.
- •Force required to break all suture constructs increased after incubation in phosphate buffered saline, suggesting initial strength gain.