title: In vivo knot scoring model for a multifilament suture.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Aesculap AG, Am Aesculap Platz, Tuttlingen, Germany. rainer.bargon@aesculap.de
authors.forename: Rainer M
authors.initials: RM
authors.lastname: Bargon
authors.forename: Erich K
authors.initials: EK
authors.lastname: Odermatt
authors.forename: Dieter
authors.initials: D
authors.lastname: Menne
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D008297:Male; D018482:Muscle, Skeletal / Q000601:surgery*; D011817:Rabbits; D013529:Surgical Wound Dehiscence / Q000517:prevention & control*; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures / Q000592:standards*; D013718:Tensile Strength