Surgical knot performance in sutures

Abstract The chapter describes procedures and materials used and results obtained from several important studies of the mechanical performance of surgical sutures and the chnical factors that influence their behavior. Key features of successful suture assembly are the material used, structure of the thread, surface treatment, knot strength, and security, the in vivo environment and compatibihty of the tensile properties of the thread with those of the tissues approximated during and after surgery. To improve suture success in terms, particularly, of knot performance, couphng of thermal and chemical energies in conjunction with mechanical interlacing have been experimented with. 

Key words knot security, knot strength, shppage, knot factors, role of friction, secure knot model, behavior in dynamic tests, knot and adhesive, knot and laser. 

A new concept in the field of sutures is the development of barbed material, which is a monofilament product that has micromechanically machined barbs on the surface. The presence of barbs, which are either mono- or bidirectionally oriented, allows sutures to be held in tissues without a 

The changes in tensile properties were evaluated using two commercially available sutures Ethicon surgical silk and Mersilene , both in sizes 1/0, 2/0,3/0, and 4/0. Controlled knots were constructed on the device shown in Fig. 12.1, which also illustrates the principle involved. The suture is looped around two posts, set 2 (5 cm) apart. The first two throws are tied in the middle of the front post one end of the suture is clamped securely while the other is subjected to the required tension. The latter was maintained constant for 5 sec, it was then released, the ends undamped, the next throw tied. 

1 Device used for constructing controlled knots (a) the schematic of the device (b) the principle involved. 

---