In vitro evaluation of the modified forwarder knot used to end a continuous suture pattern in large‐gauge suture

Objective To evaluate the strength and size of forwarder end (FE) knots modified to end continuous suture lines compared with Aberdeen (AB), square (SQ), and surgeon's (SU) knots. Study design In vitro mechanical study. Study population Knotted suture. Methods Knots were tied with 2 USP (United States Pharmacopeia) polydioxanone, 2 USP, and 3 USP polyglactin 910 and tested on a universal testing machine under linear tension. Mode of failure and knot holding capacity (KHC) were recorded, and relative knot security (RKS) was calculated. Knot volume and weight were determined by digital micrometer and balance. Knot holding capacity, RKS, size, and weight between knot type, number of throws, and suture type and size were compared by using analysis of variance testing, with P  .080). Forwarder end/AB knots failed by suture breakage at the knot, whereas some SQ/SU knots unraveled. Forwarder end knots in 2 and 3 USP polyglactin 910 were 21.1% to 44.4% (1.2‐1.4 fold) smaller compared with SQ/SU knots (P < .028). Forwarder end knots in 2 and 3 USP polyglactin 910 were 40% to 99% (1.4‐2.0 fold) larger compared with AB knots (P < .001). Conclusion Forwarder end knots provided increased KHC/RKS compared with SQ/SU knots. Clinical relevance Forwarder end knots should be considered for closures when suture is placed under tension

In vitro evaluation of the modified forwarder knot used to end a continuous suture pattern in large-gauge suture

Objective To evaluate the strength and size of forwarder end (FE) knots modified to end continuous suture lines compared with Aberdeen (AB), square (SQ), and surgeon's (SU) knots. Study design In vitro mechanical study. Study population Knotted suture. Methods Knots were tied with 2 USP (United States Pharmacopeia) polydioxanone, 2 USP, and 3 USP polyglactin 910 and tested on a universal testing machine under linear tension. Mode of failure and knot holding capacity (KHC) were recorded, and relative knot security (RKS) was calculated. Knot volume and weight were determined by digital micrometer and balance. Knot holding capacity, RKS, size, and weight between knot type, number of throws, and suture type and size were compared by using analysis of variance testing, with P  Results In all suture types and number of throws, FE knot KHC/RKS was 28% to 66.99% (1.2‐1.6 fold) stronger compared with SQ/SU knots (P  .080). Forwarder end/AB knots failed by suture breakage at the knot, whereas some SQ/SU knots unraveled. Forwarder end knots in 2 and 3 USP polyglactin 910 were 21.1% to 44.4% (1.2‐1.4 fold) smaller compared with SQ/SU knots (P  Conclusion Forwarder end knots provided increased KHC/RKS compared with SQ/SU knots. Clinical relevance Forwarder end knots should be considered for closures when suture is placed under tension.This article is published as Gillen, Alex, Amelia Munsterman, Erin Barrett, Stephanie Caston, Kevin Kersh, Dane Tatarniuk, Tamara Swor, and R. Reid Hanson. "In vitro evaluation of the modified forwarder knot used to end a continuous suture pattern in large-gauge suture." Veterinary Surgery (2020). DOI: 10.1111/vsu.13519. Posted with permission.</p

Evaluation of the in vitro performance of the double forwarder knot, compared to square and surgeon's knots using large gauge suture.

ObjectiveThe aim of the study was to evaluate the strength and size of the double forwarder (DF) knot in 2 and 3 USP polyglactin 910 when used to form a ligature and to compare the knot holding capacity (KHC), size and weight of the DF knot to surgeon's (SU) and square (SQ) knots with varying numbers of throws.Study designLaboratory study.Study populationKnotted suture.MethodsKnots were tied using 2 and 3 USP polyglactin 910 and tested on a universal testing machine under linear tension. Mode of failure and (KHC) were recorded. Knot volume and weight were determined by digital micrometer and balance. KHC, size, and weight between knot type, number of throws, and suture type and size were compared using ANOVA testing, with p ResultsIn both suture types, DF knots had a higher KHC than SQ/SU knots (p  .42). All DF knots failed by suture breakage at the knot, as did all SQ/SU knots with >6 throws. DF knots in 2 and 3 USP polyglactin 910 were larger and heavier than SQ and SU knots when the same number of throws was applied (p ConclusionSelf-locking DF knots provided increased strength compared to SU/SQ in large gauge suture but only when fewer than six throws are applied to SU/SQ knots.Clinical relevanceThe new DF knot could be an alternative for a secure ligature