Security Comparison of Various Surgical Knots Using Nylon Suture

SooA Lim; Dong Yun Lee; GyeongHyeon Doh; YeongKwon Seo; ChiYeon Lim; JungSoo Yoon; SuRak Eo

doi:10.1097/ASW.0000000000000123

Security Comparison of Various Surgical Knots Using Nylon Suture

Adv Skin Wound Care. 2024 Apr 10. doi: 10.1097/ASW.0000000000000123. Online ahead of print.

Authors

SooA Lim¹, Dong Yun Lee, GyeongHyeon Doh, YeongKwon Seo, ChiYeon Lim, JungSoo Yoon, SuRak Eo

Affiliation

¹ At DongGuk University International Hospital, DongGuk University School of Medicine, Seoul, South Korea, SooA Lim, MD, PhD, is Associate Professor, Department of Plastic and Reconstructive Surgery; Dong Yun Lee, MD, is Chief Resident, Department of Plastic and Reconstructive Surgery; GyeongHyeon Doh, MD, is Resident, Department of Plastic and Reconstructive Surgery; YeongKwon Seo, PhD, is Professor, Department of Biosystems; ChiYeon Lim, PhD, is Professor, Department of Statistics; JungSoo Yoon, MD, PhD, is Assistant Professor, Department of Plastic and Reconstructive Surgery; and SuRak Eo, MD, PhD is Professor, Department of Plastic and Reconstructive Surgery. The authors have disclosed no financial relationships related to this article. Submitted February 28, 2023; accepted in revised form May 23, 2023.

PMID: 38595155
DOI: 10.1097/ASW.0000000000000123

Abstract

Objective: To evaluate the strengths of various surgical knot techniques, including square knot, surgeon's knot, granny knot, and random knot with the same three throws.

Methods: The authors tested each of the four knot techniques using four different gauges of nylon (polyamide [Ethicon]): 4-0, 5-0, 6-0, and 7-0. Each knot type was tested 20 times per nylon gauge, for a total of 320 knots tested. The authors used a static pull machine to measure elongation at yield and maximal force to break.

Results: A comparison of elongation at yield revealed that the surgeon's knot was superior to the square knot, granny knot, and random knots across all gauges of nylons. Further, a comparison of maximal force to break revealed that the surgeon's knot was superior to the square knot, granny knot, and random knots when using 4-0, 5-0, and 6-0 nylon but not when using 7-0 nylon.

Conclusions: The surgeon's knot was the strongest, and random knot was the weakest when the authors used nylon 4-0, 5-0, and 6-0. While handling fine suture materials such as 7-0 nylon, knot failure appears to be unrelated to the knot technique used. This study provides not only fundamental guidance for tying surgical knots using nylon, but also a rational basis for an adequately strong knot choice in various fields of surgery.