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In vitro holding security of six friction knots used as a first throw in the creation of a vascular ligation

Kurtis M. HazenfieldDepartment of Small Animal Surgery, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523.

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Daniel D. SmeakDepartment of Small Animal Surgery, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523.

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Abstract

Objective—To compare in vitro security of 6 friction knots used as a first throw in the creation of a vascular ligation.

Design—Experimental study.

Sample—20 constructs of 6 friction knots created with 2–0 polyglyconate suture.

Procedures—Security of the surgeon's throw, Miller's knot, Ashley modification of the Miller's knot, modified Miller's hand-tie, constrictor knot, and strangle knot was evaluated. Each knot configuration was constructed around each of 2 balloon dilation catheters used as small- and large-diameter vascular pedicle models and pressure tested to failure (leakage) 10 times. Results were compared by means of ANOVA and Student t tests.

Results—Mean leakage pressure for the surgeon's throw was significantly lower than that of all other knots tested in both pedicle models. The Miller's knot, constrictor knot, and strangle knot had mean leakage pressures > 360 mm Hg regardless of model diameter, whereas the surgeon's throw, Ashley modification of the Miller's knot, and modified Miller's hand tie consistently leaked at pressures at or below those found in arteries under normal physiologic conditions (pressures of 90 to 140 mm Hg).

Conclusions and Clinical Relevance—Security of the Miller's knot, constrictor knot, and strangle knot was considered excellent. In vitro results suggested that, when constructed correctly, these friction knots may be preferable first-throw constructs during vascular pedicle ligation and should be further evaluated for clinical use. The surgeon's throw was less reliable as a first throw for vascular pedicle ligation in the model tested.

Abstract

Objective—To compare in vitro security of 6 friction knots used as a first throw in the creation of a vascular ligation.

Design—Experimental study.

Sample—20 constructs of 6 friction knots created with 2–0 polyglyconate suture.

Procedures—Security of the surgeon's throw, Miller's knot, Ashley modification of the Miller's knot, modified Miller's hand-tie, constrictor knot, and strangle knot was evaluated. Each knot configuration was constructed around each of 2 balloon dilation catheters used as small- and large-diameter vascular pedicle models and pressure tested to failure (leakage) 10 times. Results were compared by means of ANOVA and Student t tests.

Results—Mean leakage pressure for the surgeon's throw was significantly lower than that of all other knots tested in both pedicle models. The Miller's knot, constrictor knot, and strangle knot had mean leakage pressures > 360 mm Hg regardless of model diameter, whereas the surgeon's throw, Ashley modification of the Miller's knot, and modified Miller's hand tie consistently leaked at pressures at or below those found in arteries under normal physiologic conditions (pressures of 90 to 140 mm Hg).

Conclusions and Clinical Relevance—Security of the Miller's knot, constrictor knot, and strangle knot was considered excellent. In vitro results suggested that, when constructed correctly, these friction knots may be preferable first-throw constructs during vascular pedicle ligation and should be further evaluated for clinical use. The surgeon's throw was less reliable as a first throw for vascular pedicle ligation in the model tested.

Contributor Notes

Covidien donated 2–0 polyglyconate suture material.

Address correspondence to Dr. Smeak (Dan.Smeak@colostate.edu).