Despite the latest polymer materials and surgical suturing techniques, the knot will always be the weakest point of the tied suture loop. In theory, the knot must be as small as possible to prevent an excessive amount of tissue reaction and a delay in healing. There have been reports suggesting that topical cyanoacrylate adhesives could have a reinforcing effect on a surgeonâs knot. Such an outcome could lead to the elimination of knot slippage and the unsatisfactory performance of some surgical knots. The main purpose of this study was to determine if cyanoacrylate adhesive could have a significant reinforcing effect on typical suture types and sizes when tied as a surgeonâs knot. The second aim was to evaluate if the cyanoacrylate adhesive could replace an additional throw in the surgeonâs knot so as to achieve an equivalent mechanical performance. The topical cyanoacrylate adhesive LiquiBand® was combined with six different suture materials (TicronTM, SurgidacTM, Ethilon*, Nurolon*, BiosynTM and PDS*II) in four different sizes (USP 5-0, USP 3-0, USP 0 and USP 1). The surgeonâs knot (2=1) with and without one (2=1=1) and two additional throws (2=1=1=1) were tied in a reproducible way and mechanically tested. Six dependent variables were used to evaluate the performance of each knot with and without adhesive. The performance criteria were: the force at loop failure, the maximum loop-holding force, the loop holding capacity, the knot efficiency, the knot elongation efficiency and the loop distraction. From the results and from scanning electron microscopic observations of the reinforced knots, the cyanoacrylate adhesive was found to significantly improve the knot performance. The improvement was superior with braided sutures and with absorbable polymer sutures. The reinforcement was more significant with thicker suture sizes and with the plain surgeonâs knot. Finally, it was found that, according to the six performance criteria, the cyanoacrylate adhesive could not replace an additional throw in the surgeonâs knot.
| Identifer | oai:union.ndltd.org:NCSU/oai:NCSU:etd-03212009-112007 |
| Date | 16 April 2009 |
| Creators | Samson, Genevieve |
| Contributors | Tushar K. Ghosh, Hechmi Hamouda, Martin W. King, Bhupender S. Gupta |
| Publisher | NCSU |
| Source Sets | North Carolina State University |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://www.lib.ncsu.edu/theses/available/etd-03212009-112007/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dis sertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to NC State University or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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