Product Manual

The wounds were closed with size 4/0 Polysorb™ or Coated Vicryl™ (Ethicon, Inc.,
Somerville, NJ) sutures. Each incision was closed with five interrupted, subcuticular,
vertical loops secured with a surgeon’s knot. The loops were secured with 3-throw
knots in one pig, 4-throw knots in the second pig, and 5-throw knots in the third pig.
The swine model reproduced the human clinical experience and suture extrusion,
wound dehiscence, stitch abscess, and granuloma formation were all observed. The
cumulative incidence of suture extrusion over 5 weeks ranged from 10 to 33%. Coated
Vicryl™ sutures had a higher mean cumulative incidence of suture extrusion than that
of Polysorb™ sutures (31% vs. 19%). With Polysorb™ sutures, the 5-throw surgeon’s
knots had a higher cumulative incidence of suture extrusion than the 3-throw or 4-
throw surgeon’s knot square, 30% vs. 17% and 10%, respectively. This swine model
offers an opportunity to study the parameters that influence suture extrusion. Because
the volume of suture material in the wound is obviously a critical determinant of suture
extrusion, it is imperative that the surgeon construct a knot that fails by breakage,
rather than by slippage with the least number of throws. Because both braided
absorbable suture materials are constructed with a secure surgical knot that fails only
by breakage rather than slippage with a 3-throw surgeon’s knot square (2 =1 = 1), the
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