The use of tissue adhesive to improve knot security

One of the latest developments in the field of closure is the availability of dermal liquid adhesives that can be used to close incisions. These are cyanoacrylate-based adhesives that are FDA approved and, although largely recommended for external use, they are bioabsorbable and, therefore, present the potential for use in conjunction with a knot for internal application. A study at North Carolina State University examined the efficacy on knot characteristics of coupling such adhesive with a number of surgeon s knots in a number of suture materials that differed in construction, size, and absorbability.  

Note The values given are the mean and the standard deviation. 

Ideally, a knot should not only be secure but also small. One way to achieve this objective is to couple the energy from an auxiliary source with the restraint obtained from the mechanical interlacing of a small knot. In limited work involving thermal energy from a CO2 laser or chemical energy from a cyanoacrylate tissue adhesive, it has been shown that the KHF of a small (two- or three-throw) knot could be enhanced. While benefits were noted in most materials, in some they tended to be optimum. As knot security and strength continue to be very important parameters in sutures, further work using techniques such as these should be pursued. 

Merchant, L. H., Knapp, S. and Apter, J. T., Effect of elongation rate on the percentage elongation of surgical sntnre materials Surg. Gynecol. Obstet, 139, 1974,389-391. 

and Postlethwait, R. W., An analysis of surgical knot security in sutures , in Biomaterials 1980 (Winter, Gibbons and Plenk, Eds), John Wiley and Sons, 1982,661-668. 

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