Comparison of sliding self-locking knots efficacy in nasal septum surgery. (Experimental study)

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Sutural fixation of the operated structures is an important stage impacted on the postoperative period in modern rhinosurgery. However, it’s difficult to tie a classical surgeon’s knot in deep parts of nasal cavity due to anatomical features. Objective. To conduct the comparative assessment of efficacy and reliability of sliding and fixing properties of the most common sliding knots in the experiment. Material and methods. The study objects were 4 sliding self-locking knots, specifically «Chula knot», «Sliding-lock knot», «Osaka sliding knot» and «semi-fishing knot» with use PDS 5/0 and Vicryl 5/0 sutures. Knots were formed, tightened and stretched on 2 mm by one doctor, by 30 samples of each knot on the bridge tensometric sensors with pretwisted screw. The signal was converted into a data stream presented in Newton (N). Each knot was assessed according to two characteristics: easiness of gliding and strength of knot. Results. In the group of knots, formed by PDS 5/0 suture, the easiness of gliding was 0.07 [0.06; 0.08], that significantly better than indicators of Vicryl 5/0 suture, which were equal 0.13 [0.11; 0.15]. Moreover, while compare of the groups of knots, «semi-fishing knot» showed the best result with value of 0.07 [0.05; 0.09], then «Sliding-lock knot» (0.09 [0.07; 0.12]) and «Osaka sliding knot» (0.11 [0.08; 0.14]) were followed. The greatest force applied to tightening and stretching was noted for the «Chula» knot: 0.12 [0.09; 0.15] and 1.21 [1.03; 1.39] respectively. Combination of «Chula» knot and Vicryl 5/0 suture had the greatest resistance to the inverse sliding — 1.39 [1.38; 1.4]. Conclusion. Performed study completely assessed the sliding easiness and strength of 4 types of sliding self-locking knots with use of 2 types of suture material: PDS 5/0 and Vicryl 5/0. The simplest configuration of «semi-fishing knot» in combination with PDS 5/0 monofilament provides the greatest easiness of knot sliding during its tightening. Obtained results should be used in surgical practice. However, the choice of optimal combination of knot and suture material with consideration to mechanical characteristics is left to the surgeon in each certain case.