Journal of Surgical Education
Volume 67, Issue 4 , Pages 222-226 , July 2010

Tensile Strength of a Surgeon's or a Square Knot

Accepted as an oral-poster at the 36th Annual Meeting of the Society for Gynecologic Surgery, Tuscon, Arizona, April 14, 2010.

  • Tyler M. Muffly, MD

      Affiliations

    • Center of Urogynecology and Pelvic Floor Disorders, Obstetrics, Gynecology & Women’s Health Institute, Cleveland Clinic, Ohio
    • Corresponding Author InformationCorrespondence: Inquiries to Tyler M. Muffly, MD, Fellow, Female Pelvic Medicine and Reconstructive Surgery Center of Urogynecology and Pelvic Floor Disorders, Desk A-81 Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195; fax: (216) 636 2620
    • ,
  • Jamie Boyce, DO

      Affiliations

    • University of Missouri—Kansas City, Missouri
    • ,
  • Sarah L. Kieweg, PhD

      Affiliations

    • Department of Mechanical Engineering, University of Kansas, Lawrence
    • ,
  • Aaron J. Bonham, MS

      Affiliations

    • University of Missouri—Kansas City, Missouri

References 

  1. In:  Dunn DL editors. Wound Closure Manual. Somerville, NJ: Ethicon Inc; 2007;
  2. In:  Graumont R,  Hensel J editor. Encyclopedia of Knots and Fancy Rope Work. 4th ed.. Atglen, PA: Schiffer; 1952;
  3. Behm T, Unger JB, Ivy JJ, et al. Flat square knots: are 3 throws enough?. Am J Obstet Gynecol. 2007;197:e1–e3
  4. van Rijssel EJ, Trimbos JB, Booster MH. Mechanical performance of square knots and sliding knots in surgery: comparative study. Am J Obstet Gynecol. 1990;162:93–97
  5. Gallup DG. Opening and closing the abdomen and wound healing. In:  DeCherney A editors. Gershensen DM CS Operative Gynecology. 2nd ed.. Philadelphia, PA: WB Saunders; 2001;p. 195
  6. In:  Grody MH editors. Benign Postreproductive Gynecologic Surgery. 1st ed.. New York, NY: McGraw-Hill; 1995;
  7. Hogston P. Suture choice in general gynaecological surgery. Obstet Gynaecol. 2001;3:127–131
  8. Dang MC, Thacker JG, Hwang JC, Rodeheaver GT, Melton SM, Edlich RF. Some biomechanical considerations of polytetrafluoroethylene sutures. Arch Surg. 1990;125:647–650
  9. Jones K, FA, Abramowitch D, Moalli PA. Evidence against the need for permanent suture for graft placement at the time of abdominal sacral colpopexy. American Urogynecologic Society 30th Annual Meeting, Hollywood, FL, 2009.
  10. Imparato E, Aspesi G, Rovetta E, Presti M. Surgical management and prevention of vaginal vault prolapse. Surg Gynecol Obstet. 1992;175:233–237
  11. In:  Ratner B HA,  Schoen FJ,  Lemons JE editor. Biomaterials Science: An Introduction to Materials in Medicine. 2nd ed.. London, England: Elsevier; 2004;
  12. Kadirkamanathan SS, Shelton JC, Hepworth CC, Laufer JG, Swain CP. A comparison of the strength of knots tied by hand and at laparoscopy. J Am Coll Surg. 1996;182:46–54
  13. Muffly TM, Cook C, Distasio J, Bonham AJ, Blandon RE. Suture end length as a function of Knot integrity. J Surg Educ. 2009;66:276–280
  14. Zimmer CA, Thacker JG, Powell DM, et al. Influence of knot configuration and tying technique on the mechanical performance of sutures. J Emerg Med. 1991;9:107–113
  15. In:  Edlich RF editors. Surgical Knot Tying Manual. 3rd ed.. Oneonta, NY: Covidien; 2008;
  16. Nout E, Lange JF, Salu NE, et al. Creep behavior of commonly used suture materials in abdominal wall surgery. J Surg Res. 2007;138:51–55
  17. Mens J, Hoek van Dijke G, Pool-Goudzwaard A, van der Hulst V, Stam H. Possible harmful effects of high intra-abdominal pressure on the pelvic girdle. J Biomech. 2006;39:627–635
  18. Gerten KA, Richter HE, Wheeler TL, et al. Intraabdominal pressure changes associated with lifting: implications for postoperative activity restrictions. Am J Obstet Gynecol. 2008;198:e1–e5
  19. Barnhart KT, Izquierdo A, Pretorius ES, Shera DM, Shabbout M, Shaunik A. Baseline dimensions of the human vagina. Hum Reprod. 2006;21:1618–1622
  20. Cosson M, Lambaudie E, Boukerrou M, Lobry P, Crépin G, Ego A. A biomechanical study of the strength of vaginal tissues (Results on 16 post-menopausal patients presenting with genital prolapse). Eur J Obstet Gynecol Reprod Biol. 2004;112:201–205

PII: S1931-7204(10)00175-3

doi: 10.1016/j.jsurg.2010.06.007

Journal of Surgical Education
Volume 67, Issue 4 , Pages 222-226 , July 2010

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