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In Vivo Knot Scoring Model for a Multifilament Suture

Bargon, Rainer M. PhD*; Odermatt, Erich K. PhD*; Menne, Dieter PhD

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques: June 2011 - Volume 21 - Issue 3 - p e120–e125
doi: 10.1097/SLE.0b013e31821a8596
Online Articles: Technical Reports

Background A surgical knot is the key feature to assure appropriate wound support while combining tissue edges. Little evidence is available on the in vivo behavior of knots and the evaluation of knots in the living tissue. This study introduces a knot score model, which is defined by microscopic evaluation and the loop-holding capacity.

Materials In a double-blinded and comparative study, 3 surgeons placed 10 intramuscular single-loop sutures in the longissimus muscle group of the dorsolumbar region at each side parallel to the vertrebral column. For accomplishing the study, 72 rabbits and 3 calibers of a test and control suture were used. On the fourth day, the knot safety was assessed by microscopical and mechanical analyses for scoring and classifying the knots of the different suture materials into the defined categories for loop-holding capacity. The statistical evaluation was performed using Hodges-Lehmann rank score. A Wilcoxon test was used to estabilish a significant difference between the suture types.

Results When comparing Novosyn (Aesculap AG) with Vicryl (Johnson & Johnson Medical GmbH) a comparable knot safety was assessed based on a 95% confidence interval.

Conclusions The new method compares the knot safety between 2 braided multifilament sutures in the living tissue. Results were discussed and examined for statistical significance.

*Aesculap AG, Am Aesculap Platz, Tuttlingen, Germany

Menne Biomed Consulting, Olgastraße 7, Tübingen, Germany

The investigation was conducted at FREY-TOX GmbH, 04916 Herzberg, Germany.

Reprints: Rainer M. Bargon, PhD, Aesculap AG, Am Aesculap Platz, 78532 Tuttlingen, Germany (e-mail:

Received February 9, 2010

Accepted March 15, 2011

© 2011 Lippincott Williams & Wilkins, Inc.