Product Manual

are intertwined with the single strand of the fixed suture end. When knot construction

is complete, the interrupted percutaneous suture has two cut suture ends. Knots

constructed by a double-strand suture loop and a single strand of the fixed suture end

has three separate knot ears (Figure 7). The square knot is formed when the right ear

and the loop of a two-throw knot exit on the same side of the knot and are parallel to

each other.

During wound closure, knot construction involves two steps. The first secures precise

approximation of the wound edges by advancing either a one-throw or a two-throw

knot to the wound surface. The second step is the construction of additional throws

until knot security is attained and slippage is prevented.

Our biomechanical performance studies demonstrate that secure knot configuration

of the interrupted suture loop created at the beginning of the wound is quite

different from secure knot configuration of the knot constructed at the end of the

wound. These differences in secure knot configurations are related to the types of

suture strands used in knot construction. The first knot in a continuous suture is

constructed by two single strands, and the second knot is created by a single strand

and a suture loop. Knot construction with a suture loop predisposes the knot to suture

slippage and requires additional throws for knot security. When constructing the

first interrupted suture loop with either absorbable or nonabsorbable monofilament

sutures, knot security is achieved with square knot construction by using three or four

throws. The last suture loop and single strand involves at least five or six throws for

knot security. If the trauma surgeon fails to construct secure knots at the beginning or

the end of the laceration, knot slippage will occur, resulting in wound dehiscence.