Bursting strength of surgeon's and self-locking knots for closure of ventral midline celiotomy in horses

Objective: To compare the bursting strength and failure mode of ventral midline celiotomy closed with a simple continuous suture pattern with 1 of 2 knot combinations, a novel self-locking knot combination of a forwarder start with an Aberdeen end knot (F-A) and a traditional combination of a surgeon's start with a surgeon's end knot (S-S). 
Study design: Ex vivo experimental. 
Sample population: Equine cadavers (n = 14). 
Methods: A 20-cm ventral midline celiotomy was created in 14 equine cadavers. Horses were assigned to celiotomy closure with an F-A or S-S knot combination. Prior to closure, a 200-L inflatable bladder was placed in the abdomen and then insufflated until failure of the celiotomy closure. The horses’ signalment, weight, breed, and age, as well as knot combination type, mode of failure, closure time, and bursting strength (mm Hg) were recorded. 
Results: The median bursting strength was significantly greater when incisions were closed with the F-A knot combination (388 mm Hg) compared with the S-S knot combination (290 mm Hg) (P =.035). Most incisions failed along the fascia when closed with F-A combinations and at the knot when closed with S-S combinations. 
Conclusion: The bursting strength of ventral midline incisions in equine cadavers was increased by an average of 25% when closed with the self-locking F-A knot combination. 
Clinical significance: Closing ventral midline celiotomies with an F-A knot combination may provide a more secure closure than the traditional S-S knot combination. Additional in vivo investigation is required prior to recommending this closure in clinical cases.