medRxiv preprint doi: https://doi.org/10.1101/2021.04.12.21255295; this version posted April 15, 2021. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission. How to tie dangerous surgical knots – easily. Can we avoid this? E H Drabble**, S Spanopoulou*, E. Sioka*, E Politaki*, I K Paraskeva*, E Palla*, L Stockley***, D Zacharoulis* (* University of Thessaly, Greece, **Clinical lead BSS course RCS England, Consultant Surgeon, University of Plymouth Hospitals NHS Trust***University of Plymouth, England) (Data statement: 'Technical appendix, statistical code, and dataset available from the Univrersity of Plymouth Data repositry Corresponding author: Eric Drabble, c/o 42 Skylark Rise, Plymouth PL6 7SN, Devon, UK
[email protected] +44 7533 186772 Abstract Objective: Secure knots are essential. Previous publications have concentrated on security of different knot types, but could individual technique be important? Determine whether the technique of formation of each layer of a surgical knot is important to the security of the knot formed. Design study: Prospective analysis of technique on knot security Materials and methods: Senior and resident surgeons, and medical students, tied knots with three techniques, using four study materials, 2/0 polyglactin 910 (vicryl), 3/0 polydioxanone (PDS), 4/0 poliglecaprone 25 (monocryl) and 1 nylon (Ethilon); a standard flat reef knot (FRK), knots tied under tension (TK), and knots laid without appropriate hand crossing (NHCK). Each knot technique was performed reproducibly, and security determined by distraction with increasing force, till each material broke, or the knot separated completely.