title: Tying a loop-to-strand suture: is it safe?
abstract: OBJECTIVE
  This study was undertaken to evaluate the integrity of the loop-to-strand knot when tied with square and nonidentical sliding knots.
  
  
  METHODS
  The synthetic absorbable monofilament suture poliglecaprone 25 in 0 and 2-0 suture gauges was used in this experiment. For each suture gauge, 3 groups of knots were tested: (1) single strand-to-single strand, flat square knot, (2) loop-to-single strand, flat square knot, and (3) loop-to-single strand, nonidentical sliding knot. All knots were tied with 6 throws. The proportion of knots becoming untied was compared among the 3 groups for each suture gauge. Ultimate load required to untie or break knots within each group was also evaluated.
  
  
  RESULTS
  The loop-to-strand knot performed well in both suture gauges tested as long as it was tied with a flat square knot. The loop-to-strand knot tied with a nonidentical sliding knot had an unacceptably high failure rate.
  
  
  CONCLUSIONS
  The loop-to-strand termination of a continuous suture may be acceptable when tied with a 6-throw flat square knot but not acceptable if tied with sliding knots.
authors.affiliation: Division of Gynecologic Pelvic Surgery, Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Hurt
authors.forename: James B
authors.initials: JB
authors.lastname: Unger
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Ivy
authors.forename: Debi
authors.initials: D
authors.lastname: Mukherjee
authors.forename: Antonio
authors.initials: A
authors.lastname: Pizzaro
mesh_terms: D002398:Catgut; D004146:Dioxanes / Q000737:chemistry*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000295:instrumentation / Q000379:methods; D006801:Humans; D008422:Materials Testing; D011091:Polyesters / Q000737:chemistry*; D012449:Safety; D012680:Sensitivity and Specificity; D013536:Suture Techniques; D013537:Sutures; D013718:Tensile Strength
chemical_list: D004146:Dioxanes; D011091:Polyesters; C095495:glycolide E-caprolactone copolymer