Journal Basic Info

  • Impact Factor: 1.989**
  • H-Index: 6
  • ISSN: 2637-4625
  • DOI: 10.25107/2637-4625
**Impact Factor calculated based on Google Scholar Citations. Please contact us for any more details.

Major Scope

  •  Ophthalmology
  •  Oral & Maxillofacial Surgery
  •  Podiatric Surgery
  •  Aesthetic & Cosmetic Surgery
  •  Gynecological Surgery
  •  Vascular Surgery
  •  Gastroenterological Surgery
  •  Robotic Surgery


Citation: World J Surg Surg Res. 2024;7(1):1540.DOI: 10.25107/2637-4625.1540

Biomechanical Investigation of the 0° Longitudinal Pull versus the 90° Transverse Pull Force on Knot Security

Lin SY, McGrouther DA and Wong YR

Yong Loo Lin School of Medicine, National University of Singapore, Singapore Biomechanics Laboratory, Singapore General Hospital, Singapore Department of Hand Surgery and Reconstructive Microsurgery, Singapore General Hospital, Singapore

*Correspondance to: Wong Yoke Rung 

 PDF  Full Text Research Article | Open Access


Fewer biomechanical studies focused on the intricacies of the suturing steps and techniques and its influence on knot security. This paper aims to develop a biomechanical testing method and evaluate the biomechanical performance of reef knots made by using the 0° longitudinal pull and 90° transverse pull at the last throw. Forty samples of fresh porcine skin were sutured with either a 0° longitudinal pull (n=20) or a 90° transverse pull (n=20) using Prolene® 4.0 suture. The tying force was standardized at 4 ± 0.5 N and then survival testing on the samples was performed. The medians of the slippage/breakage force and the nth cycles before breakage were tabulated. The 0° longitudinal pull had a higher survival rate compared to the 90° transverse pull. However, statistical analysis reported no statistically significant difference in between the group of 0° longitudinal pull and 90° transverse pull for the knot strength and the nth cycles before breakage. The low survival and nth cycles before breakage of the 90° transverse pull could be attributed to the steeper learning curve. It warrants further studies to investigate the effects of different types of suture techniques, suture material and operators of a different skill level.


Biomechanical testing; Tying force; Prolene® 4.0; Reef knot; Knot configuration

Cite the Article:

Lin SY, McGrouther DA, Wong YR. Biomechanical Investigation of the 0° Longitudinal Pull versus the 90° Transverse Pull Force on Knot Security. World J Surg Surgical Res. 2024; 7: 1540..

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