title: Is the surgical knot tying technique associated with a risk for unnoticed glove perforation? An experimental study.
abstract: BACKGROUND
  The issue of safety in the surgical procedure has recently been widely and openly discussed at the World Health Organization. The use of latex gloves is the current standard of protection during surgery, as they remain intact throughout the procedure. The present study was designed to evaluate the rate of glove perforation during a two-hand technique using polyester sutures in a controlled experimental study.
  
  
  METHODS
  Hypothesis was that the gloves used during a two-hand technique using polyester suture suffer punctures. We used 150 pairs of gloves during the experiment. Each investigator performed 30 tests always using double gloving. They made five surgical knots on each test over a custom-made table specifically developed for the experiment. Ten tests were done at a time with a week- interval. The Control Group (CG) has 30 pairs of intact surgical gloves. The gloves were tested to impermeability by water filling and leaking was observed at three different times. Statistics relating to the perforation rate were analyzed using the chi-square test. A P value less than 0.05 was considered statistically significant.
  
  
  RESULTS
  During the experiment there was no loss of gloves by drilling or inadvertent error in performing the impermeability test. No perforations were detected at any time during the impermeability test with the gloves used for sutures. Also, the CG presented no leakage of the liquid used for the test. There was no statistical difference between the groups underwent suture nor between them and the GC.
  
  
  CONCLUSIONS
  Under the studied conditions, the authors' hypotheses could not be proved. There was no damage to the surgical gloves during the entire experiment. The authors believe that the skin abrasions observed in the ulnar side of the little finger, constant throughout the experiment, must be caused by friction. We feel there is no risk of perforation of surgical gloves during a two-hand technique using polyester suture.
authors.affiliation: Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, R. Carlos Góis 375/203 Leblon, 22440-040 Rio de Janeiro, RJ, Brazil.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Giordano
authors.affiliation: Departamento de Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro 21941-590, RJ, Brazil.
authors.forename: Hilton Augusto
authors.initials: HA
authors.lastname: Koch
authors.affiliation: Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, R. Carlos Góis 375/203 Leblon, 22440-040 Rio de Janeiro, RJ, Brazil.
authors.forename: Juliano
authors.initials: J
authors.lastname: de Sousa Prado
authors.affiliation: Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, R. Carlos Góis 375/203 Leblon, 22440-040 Rio de Janeiro, RJ, Brazil.
authors.forename: Leonardo Schiavo
authors.initials: LS
authors.lastname: de Morais
authors.affiliation: Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, R. Carlos Góis 375/203 Leblon, 22440-040 Rio de Janeiro, RJ, Brazil.
authors.forename: Rafael
authors.initials: R
authors.lastname: de Araújo Hara
authors.affiliation: Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, R. Carlos Góis 375/203 Leblon, 22440-040 Rio de Janeiro, RJ, Brazil.
authors.forename: Felipe Serrão
authors.initials: FS
authors.lastname: de Souza
authors.affiliation: Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, R. Carlos Góis 375/203 Leblon, 22440-040 Rio de Janeiro, RJ, Brazil.
authors.forename: Ney Pecegueiro
authors.initials: NP
authors.lastname: do Amaral
keywords: Impermeability testing; Surgical gloves; Sutures