Knot security requires the accepted surgical technique of at least 4 alternating throws. The initial 2 throws can be square, surgeon's, or granny without a change in knot security. A fifth throw does not add to knot security. If the surgeon fails to alternate direction (or cross) the free ends of the suture creating a multiple slip knot, at least 5 throws are required to prevent knot slippage and are not recommended. Failure to adequately secure Duramesh™ can result in dehiscence and additional surgical procedures. The knot should remain buried in soft tissues, and not immediately under the dermis, to avoid palpability and possible later knot removal. The knot should NOT be placed intra-abdominally. Knot tying should be slow and deliberate to maintain the individual filaments’ integrity and avoid stripping. Duramesh™ is cut with standard surgical scissors at least 3 mm from the surgical knot.