Tensile strength and early healing of self-locking and surgeon's knots.
Authors: Weatherall Kathleen M, Boone Lindsey H, Caldwell Fred J, Cole Robert C, Cattley Russell C, Lascola Kara M, Clark-Price Stuart C, Farag Ramsis, Perkins Edmon, Hanson R Reid
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Knot Choice in Equine Celiotomy Closure Ventral midline celiotomy remains a common surgical intervention in equine practice, yet relatively little evidence exists comparing different closure techniques for their mechanical strength and healing characteristics. Researchers compared two knot combinations used to close the linea alba in 14 horses undergoing celiotomy—a self-locking knot configuration (forwarder start, Aberdeen end) versus the traditional surgeon's knot approach—by measuring tensile strength, failure patterns, and histological healing at 10 days post-operatively against control tissue from unoperated horses. Both closure methods produced equivalent biomechanical properties and healing responses (P = 0.975 for tensile strength; P = 0.600 for histology), though neither approach restored the tensile strength of intact linea alba compared with controls (P ≤ 0.001). Although the self-locking knot technique offered no mechanical advantage in this short-term study, the comparable performance warrants further investigation through longer-term clinical trials to determine whether advantages emerge during the later phases of wound remodelling or whether operational benefits such as reduced operative time influence clinical outcomes. For farriers and equine professionals involved in post-operative care, these findings suggest that knot selection should not be a primary concern when managing healing after celiotomy, with attention better directed toward appropriate activity restriction and monitoring for signs of dehiscence during the critical early healing phase.
Read the full abstract on PubMed
Practical Takeaways
- •Self-locking knots (F-A) perform as reliably as traditional surgeon's knots for closing ventral midline incisions in horses—choose based on surgeon familiarity rather than biomechanical advantage
- •Both closure techniques leave abdominal wall significantly weaker at 10 days post-op, so stall rest restrictions remain important regardless of knot choice
- •Early healing patterns are equivalent between techniques, reducing concern about switching from traditional to self-locking knots in your surgical practice
Key Findings
- •Both forwarder start-Aberdeen end (F-A) self-locking knots and surgeon's start-end (S-S) traditional knots produced significantly lower tensile strength than unincised control abdominal wall (P≤0.001) at 10 days post-closure
- •No significant differences in tensile strength (P=0.975), failure location (P=0.240), or histologic healing (P=0.600) were detected between F-A and S-S closure techniques
- •Neither knot technique restored the tensile strength of the linea alba by 10 days post-operative