Background: Surgeons are not always cognizant of the knots they tie. It has been thought that suture material does not determine what types of knots are tied.
Design: Experienced surgeons were asked to tie square monofilament knots that were salvaged and microscopically evaluated.
Results: Tightly cinched monofilament knots assume sliding conformation in vivo regardless of configuration, instrumentation, suture polymer, or surgeon.
Conclusions: When monofilament suture is securely cinched in vivo, kinetic energy forces even a flat throw into sliding conformation. A well-crafted, intentionally sliding square knot appears compacter than any other monofilament knot.
© 2013 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.