Randomized controlled trial of appendicectomy versus antibiotic therapy for acute appendicitis

Abstract

I was interested to read the article on surgical technique by Dr Di Saverio and colleagues (Br J Surg 1993; 80: 873) concerning the use of an adjustable sliding knot for securing subcuticular running sutures. This article suggested several applications for such a knot, and I would like to suggest another possible use. The technique involves using the spare length of suture to tie a sliding knot by means of two half hitches on to the end of the subcuticular suture protruding from the skin. The knot is slid to acquire the correct tension and then secured by a further knot to the protruding length. I have found this knot to be particularly useful in securing the subcuticular suture involved in Bascom’s repair for pilonidal sinus. I found acquiring the correct tension for closing the wound after ‘picking out the pits’ to be difficult with other knots. Beads and sliding buttons are to be avoided in the natal cleft.