Abstract
Introduction
Recently, a new dynamic high-strength round suture dynacord (DC) was introduced featuring a salt-infused silicone core attracting water in a fluid environment to preserve tissue approximation which is also available in tape form (DT). Study aims: (1) assess the influence of securing knot number on knot security of two double-stranded knot configurations (Cow-hitch and Nice-knot) tied with either dynamic (DC and DT) or conventional round sutures fiberwire (FW) and conventional suture tapes (ST), (2) compare the ultimate force and knot slippage of (a) Cow-hitch and Nice-knot and (b) DC and DT versus FW and FT at their minimal number of needed securing knots.
Method
Seven specimens of each FW, ST, DC and DT were considered for tying with Cow-hitch or Nice-knots. The base of these Cow-hitch and Nice-knots were secured with surgeons’ knots using 1-3 alternating throws. Tensile tests were conducted under physiologic conditions to evaluate knot slippage, ultimate force at rupture, and minimum number of knots ensuring 100% knot security
Result
100% knot security for both Cow-hitch and Nice-knots was achieved with 2 securing knots for DC, DT, ST, and with 3 securing knots for FW. With these minimum number of securing knots ultimate force was significantly higher for Nice-knots versus Cow-hitch in DT (p=0.001) and slippage was significantly higher in Cow-hitch versus Nice-knot tied with DC (p=0.019).
Conclusion
The minimum number of securing knots required to achieve 100% knot security was 2 for DC, DT and ST both with Cow-hitch and Nice-knots. In contrast, 3 securing knots were needed in FW. With these minimum number of securing knots Nice-knots were associated with higher ultimate forces in DT and lower slippage in DC versus Cow-hitch knots. Furthermore, the novel self-tightening suture material (DT and DC) does not reduce slippage, which is unavoidable in all used sutures.
