Factors relating to the volume of surgical knots.

The suture's knot site represents the highest amount and density of foreign body material of a knotted suture loop. The volume of a knot is directly related to the total amount of inflammatory reaction surrounding the knot. We measured the volume of seven surgical knots frequently used in surgical practice. Two different suture materials and two different sizes were tested. Suture size was found to contribute significantly more to the volume of all knots tested than the number of throws of which the knots were composed. Knots made with coated multifilament polyglactin-910 were significantly larger than the knots made with monofilament nylon. Clinical implications of these findings are discussed. Surgical techniques keeping the volume of knots to a possible minimum, are encouraged.