The surgical knot, already in pronunciation, is associated with ease of knitting and reliability. Indeed, the knot has long been used in surgical operations where strength, compactness and simplicity are required. Anglers also introduced the practice of tying a shock leader to the main line, for mounting feeder () rigs using monolines, braided cords and thin fluorocarbon.

I will not argue and prove that a surgical knot is the best solution. There are many other methods to tie the ends of the scaffold or make a loop. It’s just that each knot is good at the right time and place, and when the angler is also able to do the right weaving with his eyes closed, it’s wonderful.

Types of surgical knots

In fact, the name "surgical knot" in medicine is applied to three knots - to the loops of a simple (female), marine and complex two-loop knot.

Simple, or feminine, is the progenitor of what we call surgical and use in fishing.
Marine made the list because of its ease of use and the presence of the required characteristics.
But the complex two (three) loop knot is just the topic of this article.

Each node has its strengths and weaknesses.

simple knot

Advantages

Ease of development;
knitting speed.

disadvantages

The desire for self-loosening, and hence the rapid loss of fastening properties.

Knot

Advantages

Ability to quickly learn.
Oddly enough (marine!) - relative strength characteristics.

disadvantages

Difficulty of implementation;
Long workouts are required.
Tends to self-untie when using synthetic monofilament threads.
According to doctors, knot ideal for working with silk threads.

Complex node

Advantages

High reliability and durability.

disadvantages

When tightening the first loop, the threads are able to fray;
Relatively large node volume (but this is important in medicine);
The complexity of knitting without practice;
Tendency to self-untie when using threads with a slippery surface;
Insufficient reliability in the presence of only the second loop. The addition of a third, "stopping" loop eliminates the disadvantage.

Well, it's probably time to stop talking and go directly to the places of use and the technique of tying the knot.

Potential Uses

The main places for using a surgical, complex, node are feeder installations. In classic spinning fishing, it is somehow customary to use specialized, less labor-intensive knots and loops. Which, by the way, are often recommended by manufacturers of braided cords, monofilament and fluorocarbon. For example, the Rappalovsky knot.

In feeder fishing, a surgical knot is used when attaching leashes with hooks, feeders, mounting fasteners and swivels, and, if necessary, tying two separate lines together.

The most common uses are asymmetrical, symmetrical, and Gardner loop diagrams.

However, there is one minus, which I kept silent about when I described the disadvantages of the node. If you believe the doctors, then when knitting surgical loops, you should take into account the fact that synthetic threads, which have significant differences in thickness and strength, do not hold the knot securely.

Therefore, to say that the knots traditionally used in fishing show their qualities worse than surgical ones - I still think this is not so. Much depends on the correctness of knitting. And also take into account what to throw loops when we are talking about maximum reliability, should be on a fishing line with a large diameter. But more on that below.

Surgical Knot Knitting Technique

What is the reliability of the surgical node? The fact that in the connected threads there is enough friction between them. It is customary for fishermen to wet surfaces with saliva or water. In this case, the fishing line heats up less during friction. In medicine, you understand, this cannot be done.

Let's start by tying a loop with a simple surgical knot. It is used to create fastening loops on leashes, someone ties a hook.

Fold the end of the string in half.

We begin to knit a simple knot.

We drag the end loop again.

We tighten.

As noted, there is nothing difficult to create a loop, which cannot be said about the knot, which is to fasten the two ends of the fishing line. Without home training, mastering fishing will be difficult.

Many anglers tie the ends of two lines with the knot described above. Yes, in some situations he is able to perform the assigned task. But as you noticed, when the shortcomings of surgical knots were described, the phrase “prone to self-untying” often caught my eye.

Doctors did not just strengthen the knot with additional loops. According to them, threads having different diameters and breaking load it doesn't matter if they keep in touch with each other. One thread is in tension, the other is in a "loose" state.

What did the health workers think? They created a complex knot, which they called a real surgical one. It has at its beginning elements of a simple (female) knot and a marine theme.

Photos are good, but hardly anyone can show everything in practice and dwell on the nuances (I could be wrong). And therefore, I propose to watch a video about coaching medical students in the technique of knitting a knot.

NHNP. Regards, Oleg

The natural development of a direct knot with the aim of strengthening it is an increase in the number of runs with running ends. This results in a more durable surgical knot compared to a direct one. In this case, you need to follow the direction of the run-outs.

On fig. 1 runs are made against the direction of movement of the clock hand, if viewed from the root of the left rope, and in Fig. 2 runs are made clockwise, if viewed in the same direction. If we do not change the direction of the run-outs in Figures 1 and 2, then we will get an improved woman's knot, not as strong as the surgical one.

It is easier to tie a surgical knot than a straight one if the rope is under tension, since after the completion of the indicated in fig. 1, the running ends do not slip, and the actions indicated in fig. 2.

Thread tying technique. Knitting knots. Technique of knitting surgical knots. How to tie a surgical knot?

All nodes used in surgical practice, double (sometimes triple). The first knot is the main one and should be tightened as much as possible. The second knot secures the first, that is, prevents it from untying, weakening. The third knot is applied when using catgut and synthetic ligatures for greater strength, since these threads are very elastic and their surface is slippery.

Surgical site. How to knit surgical knots?

Stage I - fixing the threads in starting position. The free ends of both threads are crossed and held with the thumb and forefinger of both hands.

Stage II - cross threads. The third finger of the right hand is placed over the thread fixed by this hand. The thread, fixed with the left hand, is placed on the nail phalanx of the third finger.

Stage III - taking the thread and passing it through the loop. The nail phalanx of the third finger is brought in by a thread fixed by the same hand. When the finger is extended, the thread located on its back surface is passed through the loop.

Stage IV - fixation of the thread passed through the loop. After passing through the loop, the free end of the thread is pressed thumb to the palmar surface of the third finger. In this case, the index finger is placed above the thread.

Stage V - knot tightening. The threads are taken in the opposite direction. With the index fingers of both hands, the knot is displaced towards the tissues.

Stage VI - tying the second knot. The technique of tying the second knot is similar to that of the first, but the second

the knot is tied with the opposite hand. 5th way of knitting knots.

Stage I - fixing the threads in their original position. The free ends of the crossed threads are held by III and IV fingers of both hands, and the thread held right hand, should be higher.

Stage II - cross threads. The thumb of the right hand is placed under the thread held by the same hand. The thread, fixed with the left hand, is brought under the index finger of the right hand and shifted upward, crossing with the opposite thread at the base of the nail phalanx thumb right hand.

Stage III - taking the thread and passing it through the loop. The nail phalanx of the index finger is led behind the thread held by the right hand below the intersection of the threads. When the finger is extended, the thread is passed through the loop.

Stage IV - fixation of the thread passed through the loop. The thread passed through the loop is first fixed with the thumb and forefinger of the right hand, then with the thumb and III fingers of the same hand. By the end of this step, the index finger should be above the thread.

V stage tightening the knot. The threads are taken away in opposite directions and the knot is shifted with the index fingers of both hands.

Stage VI tying the second knot. The technique for tying the second knot is similar to that of the first, but the second knot is tied with the opposite hand.

Knot tying technique. After passing the thread through the fabric, its long end is fixed with the left hand. The needle holder, held by the right hand, is placed over the long end of the thread. By turning the needle holder clockwise, the long end of the thread is wound around it, after which, having spread the jaws, the free end of the thread is captured with the needle holder. The free end of the thread, fixed with a needle holder, is passed through the loop and the knot is tightened, shifting it towards the tissues with the index finger of the left hand. To tie the second knot, the long end of the thread is also wound on the needle holder, turning it counterclockwise. If two tools are used to tie a knot, then this method is called apodactyl.

5. Surgical sutures.

Most general principle performing any seam is a careful attitude to the edges of the stitched wound. In addition, the suture should be applied, trying to accurately match the edges of the wound and the layers of the organs to be sutured. AT recent times these principles are commonly referred to as "precision".

Skin suture
When applying a skin suture, it is necessary to take into account the depth and extent of the wound, as well as the degree of divergence of its edges. The following types of sutures are most common: Continuous intradermal cosmetic suture is currently the most widely used, as it provides the best cosmetic result. Its features are good adaptation of the wound edges, good cosmetic effect and less disturbance of microcirculation compared to other types of sutures. The suture thread is carried out in the layer of the skin itself in a plane parallel to its surface. With this type of seam, to facilitate thread pulling, it is better to use monofilament threads. Absorbable sutures are often used, such as Biosyn, Monocryl, Polysorb, Dexon, Vicryl. From non-absorbable threads, monofilament polyamide and polypropylene are used. If you use polyfilament threads, then after every 6-8 cm of the suture, you need to poke out on the skin. The thread is subsequently removed in parts between these punctures.

The second most common skin suture is metal staples. Metal staples are widely used by Western surgeons as they provide a cosmetic result comparable to cosmetic sutures. Why does using parentheses give such a cosmetic result? The bracket is designed in such a way that when it is applied, the back of the bracket is over the wound. During healing, the volume of the tissue connected by the bracket increases, but the back does not press on the tissue and does not give a transverse strip (unlike a thread).

No less common is a simple nodal suture. The skin is most easily pierced with a cutting needle, and it is believed that it is better to use a “reverse cutting” needle. When using such a needle, the puncture is a triangle, the base of which faces the wound. This shape of the puncture holds the thread better. Injections and incisions should be located on the same line, strictly perpendicular to the wound, at a distance of 0.5-1 cm from its edge. The optimal distance between the stitches is 1.5-2 cm. More frequent stitches lead to impaired blood supply in the suture area, and rarer stitches make it difficult to accurately match the edges of the wound. To prevent screwing of the wound edges, which prevents healing, deeper layers must be captured more "massively" than the skin. The knot should be tightened only until the edges match, excessive force leads to disruption of the skin trophism and the formation of rough transverse stripes. In addition, these sutures are recommended to be removed as early as possible (3-5 days after the operation) for the same purpose - to prevent the formation of rough transverse bands. The tied knot should be located at the injection or injection points, but not over the wound itself.

If it is difficult to match the edges of the skin wound, a horizontal mattress U-shaped suture can be used. When applying a conventional interrupted suture to a deep wound, it is possible to leave a residual cavity. In this cavity, wound discharge can accumulate and lead to wound suppuration. It is possible to avoid suturing the wound in several floors. Floor-by-floor suturing of the wound is possible with both nodal and continuous sutures. In addition to floor suturing of the wound in such situations, a vertical mattress suture (according to Donatti) is used. In this case, the first injection is made at a distance of 2 cm or more from the edge of the wound, the needle is inserted as deep as possible to capture the bottom of the wound. The puncture on the opposite side of the wound is done at the same distance. When holding the needle in the opposite direction, the injection and injection are performed at a distance of 0.5 cm from the edges of the wound so that the thread passes through the layer of the skin itself. Threads should be tied when suturing a deep wound after all sutures have been applied - this facilitates manipulations in the depth of the wound. The use of the Donatti suture makes it possible to compare the edges of the wound even with their large diastasis.

The skin suture must be applied very carefully, since the cosmetic result of any operation depends on it. This largely determines the authority of the surgeon in patients. Inaccurate comparison of the edges of the wound leads to the formation of a rough scar. Excessive efforts when tightening the first knot are the cause of ugly transverse stripes located along the entire length of the surgical scar. This can cause patients not only moral, but also physical suffering.

Aponeurosis suture
AT last years there have been major changes in the technique of suturing the aponeurosis. The most widely used is a continuous twisting suture with synthetic absorbable sutures, such as Polysorb, Biosyn, Vicryl. In this case, threads of nominal diameter 1, 2 are used, and double threads (loop) are often used. After the initial stitching, the needle is threaded into the thread loop and tightened. Then a suture is applied. At the end, one of the threads is cut off and stitched in the opposite direction, after which both threads are sewn together. If any problems in wound healing are suspected, non-absorbable sutures such as polypropylene can be used for such a suture.

No less frequently used interrupted aponeurosis suture using non-absorbable materials such as lavsan. A general requirement for all methods of suturing the aponeurosis is thoroughness in matching the edges, excluding fat interposition. This ensures the formation of a strong scar, that is, the formation of postoperative hernias is prevented. The use of absorbable materials has led to the fact that in recent years we have practically not observed the formation of ligature fistulas.

Seam of adipose tissue and peritoneum.
Currently, among surgeons, the question of the need for a suture of fatty tissue and a suture of the peritoneum is being discussed. The peritoneum heals well even without its precise adaptation. Moreover, the use of catgut for the suture of the peritoneum causes an inflammatory reaction. Therefore, now the wounds after median laparotomy are sutured without a peritoneal suture. There are disagreements about the need for a seam of fatty tissue. As you know, the seam disrupts the blood supply and increases the likelihood of suppuration. Therefore, in the presence of adipose tissue fascia (as is the case with inguinal hernia repair), it is advisable to sew only it. With unexpressed fiber, it is not recommended to stitch it. Aspiration drainage of the residual cavity is possible.

If you consider it necessary to sew fatty tissue, then it is better to use a continuous suture with absorbable suture materials for this (monocryl material is just designed for the suture of fatty tissue and peritoneum).

Intestinal suture
Despite the fact that the intestinal suture is very diverse, only a few types of suture are most widely used. We strongly recommend that you use a single-row continuous seam as a method of choice.

The technique of applying this seam is quite simple and of the same type. The suture is used for anastomosis and incision closure. gastrointestinal tract. The distance between the stitches is 0.5 - 0.8 cm, depending on the thickness of the walls of the organs being sutured, the distance from the edge of the sutured organ to the needle insertion is 0.8 cm for the intestine, 1.0 cm for the stomach (Fig. 3) . For operations on the stomach and small intestine, we use threads with a conditional diameter of 3/0-4/0, for operations on the large intestine, threads with a diameter of 4/0-5/0. Of the other types of sutures, single-row nodal serous-muscular-submucosal sutures are used with the location of the node on the serosa (suture Pirogov).

The seam Mateshuka differs in that the node is located on the side of the intestinal lumen. The idea of the Mateshuk suture is to facilitate the migration of the thread into the intestinal lumen. This type of suture has been widely recommended when non-absorbable materials are used, in addition to giving a reaction to body tissues. With the use of synthetic absorbable threads, the problem of knot location ceases to be fundamental.

Another single-row seam - seam Gumby used in colon surgery. This suture resembles the skin suture according to Donatti. In this case, the intestine is initially pierced at a distance of at least 1 cm from the edge of the wound with a puncture of the mucous membrane. After the puncture of the second intestine, both lumen of the intestine are pierced in the opposite direction at a distance of 2-3 mm from the edge. When the suture is tightened, an accurate comparison of the serous layers of the intestinal wall occurs over a sufficiently large extent.

In this manual, we do not describe the technique of applying two- or three-row sutures, since, firstly, they are described in numerous manuals. Secondly, we believe that all methods other than single-row seam methods have no future. Staplers are often used for gastric and intestinal sutures. In this case, two methods of anastomosis are used - the first involves the imposition of an inverted anastomosis, the second - the imposition of an everted anastomosis. How it's done? When applied inverted of the anastomosis, the branches of the GIA apparatus are introduced into the lumen of the organs to be sutured, which, when used, sutures the tissues with two rows of staple sutures and dissects in the middle. In this case, a ready-made superimposed anastomosis is obtained. Depending on the length of the working part of the device, an anastomosis with a length of 5, 6, 7 and 8 cm can be applied.

In the second method, the walls of the organs are turned out in such a way that the mucous membranes of the organs to be stitched are compared. After that, the anastomosed organs are sutured using linear suture devices, such as UO-40, TA-55. Suture of hepaticocholedochus. The sutures of the bile ducts are used after choledochotomy, in case of accidental damage to the ducts. Whenever possible, a precision continuous overlap suture should be used, assuming an accurate matching of the layers of the duct wall without trapping the mucosa. Particular care should be taken to suture a thin-walled choledoch. For this, monofilament absorbable threads (biosyn) are used, with a nominal diameter of 5/0 - 7/0. This technique differs from the traditional one by increased tightness of the seam, a minimum number of complications in the early and late periods. We use this seam as a method of choice.

When applying biliodigestive anastomoses, only a single-row continuous suture is also used, which is the easiest to use and gives fewer complications. For anastomosis, absorbable monofilament or polyfilament sutures with two needles are used. Initially, the posterior lip of the anastomosis is stitched, both threads with needles are located on both sides of the future anastomosis. After that, the right and left parts of the anastomosis are alternately superimposed on the right and left, until the threads meet on the anterior lip of the anastomosis. The threads are connected to each other and after that the anastomosis is imposed.

Liver suture
To date, liver suture remains a very difficult problem. The most modern methods for preventing postoperative hemorrhage and bile leakage from the liver are ultrasonic cavitation, treatment of the hepatic parenchyma with hot air, and application of fibrin glue to the liver tissue. With this technique, the suture of the liver is not expected. However, due to the insufficient distribution of the necessary equipment, the liver suture is currently used very widely.

Mainly used various methods P- and 8-shaped seams. When suturing the gallbladder bed, it is more convenient to use a continuous overlapping suture. When suturing the liver, it is advisable to use absorbable suture materials (Polysorb, Vicryl, Dexon) of large diameters with large atraumatic blunt needles.

Vascular suture
The main requirement for a vascular suture is its tightness. The simplest technique is to apply a continuous seam without overlap. More reliable, but at the same time more complex, is a continuous mattress seam. A common disadvantage of both seams is the possibility of corrugating the vessel wall when tying the thread. Therefore, in the case of microsurgical restoration of a small-diameter vessel, the technique of a single-row interrupted suture is used. To sew the prosthesis to the vessel (if it is a polytetrafluoroethylene prosthesis), use the same thread, which allows you to get a "dry" anastomosis due to the fact that the thread completely fills the suture channel.

Tendon suture
When suturing the tendon, one should refuse to use coarse clamps, surgical tweezers. Directly for stitching the tendon, strong threads on atraumatic needles of round cross section are needed. Of the many techniques for tendon suture, the most widely used methods are Cuneo and Lange. Special attention when restoring the tendon, one should pay attention to the conditions of its regeneration sliding surface. To do this, the edges of the tendon are adapted with separate sutures using absorbable threads with a conditional diameter of 6/0-8/0. It is especially important to observe this rule when restoring the tendons of the hand. To prevent suture divergence, external immobilization of the limb in the position of maximum tendon unloading is usually required.

6. Suture material

In recent years, the attention of surgeons has been increasingly attracted by the role of suture material in the outcome of operations. And this is understandable. The suture material for most operations (with the exception of organ prosthetics) is in fact the only foreign body that remains in the tissues after the end of the operations. And it is natural that the outcome of operations not least depends on the quality, chemical composition and structure of the suture material and the reaction of the surrounding tissues to it. The use of adequate, non-reactogenic suture material is one of the components of a successful operation. In modern surgery, the choice of suture material is determined primarily by what requirements are placed on it.

Requirements for suture materials first began to be formulated in the 19th century. So, N.I. Pirogov wrote in "Principles of military field surgery": "... that material for the seam is the best, which: a) causes the least irritation in the puncture channel, b) has a smooth surface, c) does not absorb liquid from the wound, does not swell, does not go into fermentation, does not become a source of infection, d) with sufficient density and ductility, it is thin, not voluminous and does not stick together with the walls of the puncture. Here is the ideal seam. It must be admitted that Nikolai Ivanovich, in comparison with modern surgeons, was surprisingly modest in his demands. More modern requirements were formulated by Szczypinski A. in 1965.

1.Easy sterilization

2. Inertia

3. The strength of the thread should exceed the strength of the wound at all stages of its healing

4. Node reliability

5. Resistance to infection

6. Absorbability

7. Convenience in the hand (more precisely, good handling qualities)

8. Applicability for any operation

9. Lack of electronic activity

10. Absence of carcinogenic activity

11. No allergenic properties

12. The tensile strength in the knot is not lower than the strength of the thread itself

13. Low price

Let's take a closer look at some of these requirements.

Biocompatibility(inertia). In the broadest sense of the word, this is the absence of any tissue reaction to the suture material. In particular, the severity of the allergenic, toxic, teratogenic effects of the thread on the tissues of the body is assessed. Look at the nature and severity of the inflammatory reaction.

Biodegradation(absorbability). This is the ability of the material to be absorbed and excreted from the body. The purpose of the thread is either to stop bleeding from the vessel, or to connect tissues until a scar is formed. In any case, after completing its main mission, the thread becomes just a foreign body. And of course, it is ideal if, after performing its function, the thread dissolves and is excreted from the body. At the same time, the rate of loss of thread strength (the main parameter for all absorbable threads) should not exceed the rate of scar formation. Let's say, if at the seam of the aponeurosis a strong scar is formed not earlier than on the 21st day, and the thread loses its strength on the 14th day - as you understand, there is a possibility of eventration. Only the threads that connect the prosthesis with the tissues of the body should not dissolve, since a scar never forms between the prosthesis and the tissues.

Atraumatic(one of the concepts of inertia). The concept of atraumaticity is prefabricated and, in turn, includes several concepts - the surface properties of the thread All twisted or uneven threads have an uneven surface. When the thread is pulled through the tissues of the body, a “saw effect” occurs, which leads to tissue injury and increases the inflammatory response. In this regard, most braided threads are produced with a special polymer coating, which gives the thread a monofilament property on the surface (see below). Monofilament threads are basically devoid of the saw effect and are pulled through the fabric without injuring it. The strength of the knot is also related to the surface properties of the thread. As a general rule, the smoother the surface of the thread, the weaker the knot. This forces many more knots to be tied when using monofilament threads so that the thread does not come undone. By the way, one of the points of modern requirements for suture materials is the minimum number of knots necessary for its reliability. The fact is that any extra knot is a foreign suture material. The smaller the nodes, the less the inflammation reaction. - way of connecting the thread and the needle At present, there are still non-atraumatic needles, where the thread is threaded into the eye of the needle. In this case, a duplication of the thread is created and the tissue injury increases sharply when it is pulled. The basis of modern suture materials is atraumatic threads, when the thread is a continuation of the needle.

The following methods are used to connect the thread and the needle:

The needle in the eye area is cut lengthwise, unfolded, the thread is inserted inside and the needle is folded around the thread and crimped. This creates weakness needle, in which it can bend or break.

The needle is drilled with a laser beam, a thread is inserted into the hole and crimped. This method is more reliable, since the strength of the needle is preserved as much as possible.

· When using threads of especially small diameters, silt is obtained by spraying metal onto the thread, followed by chemical sharpening.

Manipulative thread properties (comfort in the hand). The handling properties of threads include elasticity and flexibility. Elasticity is one of the main physical parameters of the thread. It is more difficult for the surgeon to manipulate rigid threads, which leads to more damage fabrics. In addition, when a scar is formed, the tissues initially become inflamed and the volume of the tissue connected by the thread increases. An elastic thread stretches with an increase in the fabric, an inelastic thread cuts through the fabric. At the same time, excessive elasticity of the thread is also undesirable, as it can lead to divergence of the wound edges. It is considered optimal to increase the length of the thread by 10-20% compared to the original. With flexibility threads are associated not only manipulation convenience for the surgeon, but also less tissue trauma. It is still believed that silk has the best handling properties (it is also called the "gold standard" in surgery).

Strength threads. The stronger the thread, the smaller its diameter can be sewn into fabric. And the smaller the diameter of the thread, the less by weight of foreign suture material we leave in the tissues, and accordingly, the less pronounced the reaction of the tissues. Studies have shown that the use of a thread with a conditional diameter of 4/0 instead of 2/0 leads to a twofold decrease in tissue response. So the strength of the thread is one of the important parameters. Moreover, not so much the strength of the thread itself should be taken into account, as its strength in the knot, since for most threads the loss of strength in the knot is from 10 to 50% of the original. For absorbable suture materials, one more parameter must be taken into account - the rate of loss of strength. As we have already said, the rate of loss of thread strength should not be higher than the rate of scar formation. In surgery of the gastrointestinal tract, the scar is formed in 1-2 weeks, with the suture of the aponeurosis - in 3-4 weeks. Accordingly, it is desirable that the suture material retains sufficient strength up to 2-4 weeks after the operation (in this case, depending on the type of absorbable material, it will be necessary to use threads of different diameters).

How important the atraumatic properties of the thread are can be understood from the data of Yurlov V.V., who, by switching from non-atraumatic needles and twisted nylon to atraumatic needles and monofilament suture material, reduced the incidence of anastomotic leaks from 16.6% to 1.1 when applying colonic anastomoses %, and lethality from 26% to 3%.

Consider the classification of modern suture materials.

Classification of suture materials.

There are several signs by which suture materials are divided. According to the ability to biodegrade: all suture materials are divided into absorbable and non-absorbable.

Absorbable materials include:

catgut, collagen

Materials based on polyamides (kapron) Materials based on cellulose (occelon, kacelon)

Materials based on polyglycolides (Polysorb, Biosyn, Monosof, Vicryl, Dexon, Maxon)

Materials based on polydioxanone (polydioxanone)

Materials based on polyurethanes (polyurethane)

Non-dissolvable materials include:

Materials based on polyesters (lavsan, mersilene, etibond)

Materials based on polyolefins (surgipro, prolene, polypropylene, surgilen)

Materials based on polyvinylidene (coral)

Materials based on fluoropolymers (Gore-tex, Vitafon)

Metal-based materials (metal wire, staples)

The structure of the threads differ:

1. Monofilament ( monofilament). In cross section, such a thread is a homogeneous structure with a smooth surface. Such threads are distinguished by the absence of a “saw effect”, as a rule, by a less pronounced reaction of the body. However, even monofilament yarns are often additionally coated to improve the "pull" property and reduce the "saw effect".

2. Shed ( polyfilament) in cross section consists of many threads. In turn, distinguish

· - twisted threads. Such a thread is obtained by twisting several filaments along the axis.

· - wicker threads Such a thread is obtained by weaving many filaments like a rope.

· - complex threads. These are usually braided threads impregnated or coated with a polymeric material. Due to the polymer coating, the "saw effect" is reduced. This type of thread is currently the most common.

Let us dwell on the properties of suture materials. Initially, it is necessary to say a few words about such widely used materials as silk and catgut. Catgut thread is the most reactogenic of all currently used threads. This is the only thread that received an anaphylactic shock reaction. The use of a catgut thread can be considered an operation for transplanting foreign tissue. Experimental studies have shown that when suturing a clean wound with catgut, it is enough to introduce 100 microbial bodies of staphylococcus into it to cause suppuration. Catgut thread, even in the absence of microbes, can cause aseptic tissue necrosis.

Another disadvantage is the unpredictable timing of the loss of strength and resorption of the catgut thread. On average, the catgut thread resolves within 3 weeks, however, these terms can vary from 2 days to 6 months. At the same time, during the first five days, the catgut thread loses up to 90% of its strength. In addition, if we compare threads of the same diameter, the strength of catgut threads is less than that of synthetic absorbable threads.

All of the above leads to the fact that now in surgery there are no indications for the use of catgut. At the same time, some surgeons continue to use it and consider catgut to be a satisfactory suture material. First of all, this is due to the habit of surgeons, the lack of experience in the use of synthetic absorbable materials. However, all conducted experimental and clinical studies show the benefits of using synthetic threads. Therefore, we allow ourselves to repeat once again - in modern surgery there are no areas for the use of catgut threads.

Now a few words about silk. Silk, due to its physical properties, is considered the "gold standard" in surgery. It is soft, flexible, durable, allows you to knit two knots. However, since silk belongs to materials of natural origin, in terms of its chemical properties it is comparable only to catgut. And the reaction of inflammation to silk is only slightly less pronounced than the reaction to catgut. Silk also causes aseptic inflammation up to the formation of aseptic necrosis. When using a silk thread in the experiment, 10 microbial bodies of staphylococcus were enough to cause suppuration of the wound. Silk has a pronounced sorption capacity and wick properties, therefore it can serve as a reservoir and conductor of microbes.

In addition, silk belongs to absorbable suture materials with a resorption period of 6 months to a year, which makes it impossible to use it in prosthetics. In recent years, attempts have been made to improve the properties of silk. Thus, the company "Ethicon" produces silk impregnated with wax, which sharply reduces its wick properties. However, impregnation negatively affects the reliability of the assembly. Impregnation of silk thread with silver salts leads to the fact that silk acquires antiseptic properties and reduces the risk of suppuration. However, we want to emphasize that in modern surgery for silk, as well as for catgut, there are no areas of application. This is especially true of silk produced by the domestic industry. We want to call on surgeons stop using silk and catgut in favor of synthetic suture materials.

7. Stop bleeding in the wound.

1) Ligation of the vessel in the wound.

It is the most reliable method of stopping external bleeding. Bandaging the vessel in the wound, directly at the site of injury, is certainly preferable, since this disrupts the blood supply to a minimum amount of tissue. More often, ligation of the vessel is done during surgical treatment of the wound or during surgery. To do this, a hemostatic clamp is applied to the bleeding vessel, after which the vessel is tied up.

In cases where the vessel is visible before damage during surgery, it can be crossed between two previously applied ligatures.

2) Ligation of the vessel throughout.

The essence of the method lies in the ligation of a rather large, often main trunk proximal to the injury site. Indications for ligation of the vessel throughout (Gunter's method) are:

Bleeding from a large muscle mass, when the ends of the vessel in the wound cannot be detected (with massive bleeding from the muscles of the tongue, the lingual artery on the neck is tied up in the Pirogov triangle, with bleeding from the muscles of the buttock, the internal iliac artery);

Secondary arrosive bleeding from a purulent wound (dressing in the wound is unreliable, since arrosion of the vessel stump and recurrence of bleeding is possible, in addition, manipulations in a purulent wound can contribute to the progression of the inflammatory process).

In order to stop bleeding, an incision is made proximal to the damaged area based on topographic and anatomical data, the corresponding artery is exposed and ligated.

In this case, the ligature very reliably blocks the blood flow through the main vessel, but bleeding, although less serious, can continue due to collaterals and reverse blood flow. The main disadvantage of the method is that much more tissues are deprived of blood supply than when bandaging a wound. This method is fundamentally worse and is used as a forced measure.

3) Sewing of the vessel.

When a bleeding vessel cannot be isolated and captured with a hemostatic clamp in the wound and, therefore, bandaged, they resort to applying a purse-string or Z-shaped suture around the vessel through the surrounding tissues, followed by tightening the thread - the so-called flashing of the vessel.

4) Wound tamponade, pressure bandage.

These are methods of temporarily stopping bleeding, which can become final in case of bleeding from small-caliber vessels. After removing the pressure bandage (usually 2-3 days) or removing tampons (usually 4-5 days), bleeding may stop due to thrombosis of damaged vessels. Gauze swabs can be dry or moistened with various solutions. Biological tissues can be used as tampons: greater omentum, muscles, etc.

For epistaxis, tamponade is the method of choice. There is an anterior (carried out through the external nasal passages) and posterior tamponade

The method of posterior tamponade of the nasal cavity:

a) passing the catheter through the nose and oral cavity to the outside;

b) attaching a silk thread to the catheter;

c) reverse removal of the catheter with tampons.

5) Vascular suture and vascular reconstruction.

The imposition of a vascular suture is fundamentally best method stopping bleeding, since only with this method the blood supply to the tissues is fully preserved. The imposition of a vascular suture or prosthesis of the vessel is performed in cases where the damaged vessel cannot be turned off from the process of blood supply to tissues (large main artery or vein). These manipulations require skill and experience, therefore, they must be performed by angiosurgeons with certain tools.

The vascular suture must be highly airtight and meet the following requirements:

do not disturb the blood flow;

The lumen should contain as little suture material as possible.

There are mechanical and manual vascular sutures. The mechanical seam is superimposed by devices using tantalum staples. It is quite perfect and does not narrow the lumen of the vessel. However, hand stitching is much more common. The method of applying a vascular suture according to Carrel:

When applying it, an atraumatic non-absorbable suture material is used (threads No. 4\0-7\0, depending on the caliber of the vessel). After mobilization of the vessel and switching off its departments with the help of elastic vascular clamps, the edges of the vessel are sparingly excised. Then the ends of the vessel are stitched through all layers with three sutures-holders, which are tied and stretched. After that, the walls of the vessel are sewn between the guide seams with a continuous twisting seam.

End-to-end connection is ideal.

In the presence of a traumatic defect with a sufficiently large distance between the distal and proximal ends of the vessel, prosthetics are used - vessel replacement with an autovein or synthetic material

In case of marginal damage to the vessels, a lateral suture or a patch from the fascia, aponeurosis, autovein, or synthetic material is applied.

Stopping bleeding with marginal vascular injuries:

a) the imposition of a transverse seam;

b) the imposition of a longitudinal seam;

c) plastic side patch;

With significant traumatic injuries of large main vessels, there is a need for shunting - creating a bypass for blood flow. For this purpose, an autovein (great saphenous vein of the thigh or superficial vein of the forearm) and vascular prostheses made of synthetic materials (kapron, dacron, perlon, etc.) are also used.

6) Physical Methods:

· Exposure to low temperatures.

Under the influence of cold, a spasm of blood vessels occurs, the speed of blood flow in them slows down, which contributes to the rapid process of thrombosis.

Local hypothermia is used to prevent bleeding and hematoma formation in the early postoperative period (an ice pack is placed on the wound after surgery for 1-2 hours), with soft tissue bruises (ice pack on the first day after injury), with nosebleeds (blister with ice on the bridge of the nose), with gastric bleeding (ice pack on the epigastric region, swallowing pieces of ice, irrigation with cold solutions of a bleeding vessel during FGS).

Cryosurgery - local application of very low temperature - is used in operations on highly vascularized organs (brain, liver, kidneys), especially when removing tumors. The method is based on local tissue freezing, which promotes hemostasis.

· Exposure to high temperature.

The hemostatic effect of high temperature is based on its ability to coagulate the proteins of the vascular wall and accelerate the processes of thrombosis.

Hot solutions are used to stop bleeding during operations with damage to parenchymal organs (liver, spleen), with diffuse bleeding from bone tissue. To do this, a napkin with hot saline solution (solution temperature 50-700C) is introduced into the wound for 5-7 minutes.

Diathermocoagulation is the main way to thermally stop bleeding.

The method is based on the use of ultra-high frequency currents that cause coagulation of blood proteins and the vessel wall at the point of contact with the device tip. Along with ligation of the vessel in the wound, diathermocoagulation is the main method of stopping bleeding during surgery. With its help, you can quickly and without leaving ligatures stop bleeding from damaged vessels of subcutaneous fatty tissue, muscles, small vessels of the brain, parenchymal organs, etc. Diathermocoagulation is effective in stopping internal bleeding (coagulation of a bleeding vessel in the mucous membrane of the stomach or duodenum through a fibrogastroscope).

One of the stages of assembling feeder equipment is the creation of a single structure consisting of a feeder for feeding and a leash with hooks. After that, the resulting structure must be attached to the main fishing line. pledge good fishing that brings pleasure is a workable tackle, so the ways to connect all these elements should be simple and reliable. One of the optimal solutions in this matter is the use of a surgical knot.

Application area

Fishing tackle is connected using synthetic fishing lines or cords. At the same time, their ends must be well fixed. In the design of tackle, knots are used in attaching a leash, feeders, fasteners and any articulation of parts of the fishing line with each other.

Feeder tackle requires the use of the following nodes:

connecting the main fishing line with leashes or hooks;
for attaching fishing line to the reel;
surgical (both knot and loop).

In the process of using feeders, ordinary knots behave, to put it mildly, not satisfactorily. In the case of heavy loads, they do not always cope with them, so it will be more practical to tie surgical knots for the feeder. According to statistics, gear that uses surgical knots fails in one case out of thirty, which is almost three times less than with conventional binding methods.

An important advantage of this connection method is the ability to tie them with fishing lines of different diameters. For example, with its help it is possible to both monofilament and carbon fiber, as well as to braided fishing line. And if the load capacity of the tackle is exceeded by increasing the thickness of the fishing line, there will be no problems in tying the same leash to a new fishing line, even directly during fishing.

Attention! Fishing line for feeder fishing should have a thickness of 0.2 to 0.4 mm. In fact, it depends on the depth of the reservoir and the weight of the feeder.

Advantages and disadvantages

There are two main advantages of using nodes of this type on the feeder:

Connection strength.
The possibility of cutting the ends of the connected elements as short as possible, almost under the base.

With feeder fishing, very serious requirements are set for the reliability and strength of all gear connections, since not only hooks and a leash are involved in fishing, but also a heavy feeder.

In addition, in the event of a breakage of gear during fishing, it is with the help of a surgical knot that you can quickly repair the gear. With the relative simplicity of the scheme, the reliability of such a connection is one of the highest among fishing knots.

Externally, the scheme of the surgical knot is similar to the scheme of a double runner, since it is implemented using two turns. The differences in their schemes are that for knitting a surgical knot it is permissible to use two fishing lines of different thicknesses.

Surgical loop can be used to attach a leader or feeder to the main line. It is believed that the use of a loop will give the bait a natural natural movement.

The main disadvantage of this compound is its big sizes, in particular the width. We should not forget that when tying it, you may encounter a significant bend and slope of the main fishing line at an angle.

Mounting Features

The sequence of weaving is as follows:
1. First you need to put together the fishing line and what will be tied to it (leash, fishing line from the feeder, torn part, etc.)

2. From the lines folded together, you need to form a loop and thread both ends through it once.

3.The ends are re-threaded through the loop, and the result is a surgical knot.

4. After that, the resulting loop should be moistened with water and tightly tightened. Excess ends must be trimmed.

In some cases, not only a double, but also a triple knot of a similar shape can be used (the ends are threaded through the loop not two times, but three). However, such a construction on a fishing line is very cumbersome and inconvenient. It is used exclusively for thick lines, or for extremely powerful gear for catching large fish.

Weaving a loop has slight differences from the above sequence:

not two different fishing lines are taken, but one is folded in half;
the fold point is threaded through the loop once, not twice.

The loop is obtained by pulling the rest of the fishing line into the nodal ring.

This method of tying allows you to arbitrarily change the size of the loop. This is done by moving the place of the tie up and down along the line folded in half, as far as its length is enough.

After the size of the loop is determined, and the place of the tie is moved to the desired distance, you should wet the fishing line with water and tighten the loop.

Application with different gear

There are several rigs used in feeder fishing. The most popular are the following:

symmetrical loop;
asymmetric loop;

The purpose and functions of these snap-ins are the same, but they have serious differences in the device and methods of fastening. In all three schemes, there are connections that are preferably carried out using a surgical knot or loop. Let's consider them in detail.

Symmetric loop

This equipment has a high sensitivity, as it is used for catching carp in stagnant waters. On it, a swivel with a carabiner is attached to a double piece of fishing line after its ends are twisted. It is in this place of attachment, approximately at a distance of 10 cm from the end, that a knot should be made.

Asymmetrical loop

Usually used for catching small fish on the feeder, so it is quite sensitive. Although, this is not mandatory. The main point in the design of the gear is that the feeder with complementary foods goes a little away from the leash with bait.

In the very design of such equipment, a monofilament is used, so the use of the node in question in this case is the most rational.

The design of the equipment with an asymmetric loop allows you to use a wide variety of feeder fishing devices, changing them right during fishing, while using a surgical knot or loop to connect them.

Rig Gardner

It is used for catching fish in reservoirs with a strong current. The knot is used in all the main connection points: at the end of the equipment, to connect the feeder with complementary foods and for the leash.

The surgical knot is one of the simplest connections used in fishing. It is easy to tie, and at the same time, the connection with its help is highly reliable. An important advantage of the knot is its ability to bind fishing lines of different thicknesses, which is used in feeder equipment.

Surgical node

Fishing tackle is an important part of a fish hunter's equipment. To catch a water animal without a fishing rod and hook, you need a strong tackle. Sailors, on the other hand, need reliable methods of fastening. However, the knowledge accumulated by navigators will be useful in Everyday life. For example, needlework, climbing, both at home and at work. You will never be able to say exactly what awaits you in a few hours, and it is better to have in your stock a strong and reliable ligament technique, one of which is a surgical knot.

By an interesting coincidence, this type of knitting is called surgical by sailors, and by the adherents of Hippocrates themselves - marine. This causes inaccuracies in interpretation. Today we will tell you how to knit such weaving, what varieties it has and where it came from.

Use and features of the surgical node

An easy way to tie a thread. It is mainly used when tying two different threads with approximately the same cross-sectional diameter. It will come in handy when one of the climbing ropes broke, when fastening a household rope, to create a hammock on a tree, while traveling (Figure 1).

Suitable for a wide range of materials including:

Nylon and other synthetic fibers. In particular, vicryl, monocryl, fluorocarbon, a number of monofilaments.
Ropes made from natural materials, twine, cables, ropes, sewing threads.
Enough flexible vegetation and even dough.

Figure 1. Surgical knots are more durable

The peak load is no more than 27 kg, but it also depends on the material. It is one of the most popular in medical practice.

History reference

It began to be used in fishing after the appearance of monofilament threads like fishing line and gear based on this material. This plexus technique comes from medical textbooks and operating rooms.

In its structure, the fishing line used by fishermen is almost identical to medical ligatures, which are used in surgery to stitch tissues together at break.

According to some signs, it is similar to the woman's knot, but contradicts the principle of its construction. It will be synonymous with a double runner, because the very name “surgical” implies two turns. The manuals for the surgeon describe two main methods of knitting it - with one hand and two. While the first method is quite risky, it can still come in handy when one hand is irreparably busy.

Advantages and disadvantages

Dual Surgical has several operating configurations that are applicable based on the conditions and circumstances for which it may be used.

There are three methods for weaving this bundle:

The first of these is simple form. Strengths- easy to learn to knit even alone. Due to its simplicity, it is suitable for fast knitting. Disadvantages - a simple approach sacrifices quality and entails fragility, since it does not inherit such a property of the progenitor as resistance to unbinding.
The second is called Marine, so named for its complexity. Its positive qualities are the speed of development and the relative strength of the decoupling. But there are also disadvantages, although not too significant: the complexity of execution and, as a result, the need for long repetitions during training. This should also include the disadvantage of synthetic threads in such a nodal configuration - they do not cling to each other due to the smooth surface, therefore, they self-untie, losing their grip. Not an obvious advantage is high efficiency when made from silk threads.
A more complex version is called complex, and in this state the surgical laces are clamped firmly between each other. This is the main advantage of such a tightening, followed by relative disadvantages: the most important, perhaps, is the process of tightening the first loop, which can affect the strength of the ropes and cause chafing. The weave itself is voluminous, so it can be used as a retainer when threading a rope through a narrow hole. If you have not practiced knitting or any other craft related to the creation of bundles, then mastering this technique will be difficult, especially the first time. The same problem as all multi-knot ties - threads with a slippery surface will lead to self-loosening. If you use only two loops, then reliability does not shine, it is recommended to throw on a control loop and stop the entire weaving.

Scope of use

Love to knit? Even if not, the applications for this type of weaving are extensive, though mostly involving tying two different strands together (figure 2).

You may need to secure loads with a secure weave during construction, and mountaineering or hiking simply requires extensive knowledge of knotting.

Well, where without fishing. A torn fishing line is difficult to restore by tying two broken ends. The same applies to various types of gear, in which you need to fix the elements in a clearly defined place. In the end, the surgical knot on the bracelet will positively stand out.

Perfect for securing hammocks between two palm trees, as well as for tying your own dog to the fence. Or maybe you are tired of the classic tie on shoes, and a surgical knot is more suitable for laces. The key advantage is the unconditional resistance to self-loosening when made from natural types of threads with a large contact surface. This is equally important for equipping fishing tackle, as well as for a simple medical weave knotted bracelet. And if in the case of polymer threads this interlacing will help to fasten two broken threads in order to obtain a monolithic bond, then for natural materials this technique will allow you to fully realize the full potential of the materials used.

It is also interesting that this method can be used when knitting a piece of thread from several elements. For example, from plant materials.

Figure 2. Similar compounds are used not only in medicine, but also in fishing, tourism and mountaineering

A key factor will also be the resistance of the thread to abrasion and damage with constant friction on the contact surface, resistance to loss of elasticity. Natural threads with this quality are silk, medical ligatures, various kinds of catguts. Their natural qualities were used by doctors to obtain strong knots, and the volumetric form played a role in suturing wounds, fastening the tissues with a connective fiber by fixing them in the inlet.

In the case of catgut, the thread later dissolved in the blood, while for silk, an additional operation was required to remove the sutures. Thus, the strength characteristics of the assembly were exploited with the highest efficiency. Later, weaving began to be used when working with larger diameters of connecting material in construction. Here, the same qualities were squeezed out of the knot for which surgeons appreciated it, but the property of mobility was added.

Applications with fishing gear

Fishing tackle has a fatal flaw: they are consumables. But by improving your knitting skill, you can minimize the chance of losing valuable sinkers, hooks and mormyshkas. Surgical braiding allows different types of lines to be joined together, thus opening up new possibilities for securing the details of the tackle. Used mainly for fishing tackle feeder type, which use additional food to attract fish. Note: Since the aquatic inhabitant is almost always hungry, the feeder must be fixed firmly, otherwise there is a high risk of losing the fish and part of the equipment.

For knitting tackle, in places where it is not necessary to fasten two different fishing threads, a loopback option is used.

How is it done?

In the place where the loop is supposed to be formed, bend the thread in half, with a margin of 5 cm.
Now take the folded loop and form a ring on it as for tying a regular knot.
Pass a loop through it 3 times.
She should peek out of the ring with her eye, wrapping herself a little around a double thread.
After that, tighten the loop.

Symmetric loop

A relatively simple method of knitting tackle that uses a surgical loop knot to secure the feeder on an equal double loop without skew in length. It has an increased sensitivity to bites, suitable for fishing in calm waters without serious eddies of the current (Figure 3).

The advantage is a detachable part that can be detached from the end of the fishing line, as it is attached using the "Loop in loop" method.

It also has the property of self-cutting due to a fixed feeder. This happens thanks to a leash with a hook, which is located at a certain distance behind the feeder. Trying to grab every piece, the greedy fish swallows the hook along with the scattered lure, after which it hooks, trying to cope with it, because the feeder rests on the bottom.

Figure 3. Symmetrical loop for attaching the feeder

Where is the best place to use this tool? On reservoirs with fish stunned by hunger, which has entered the feeding stage, which loses all fear and shamelessly eats everything it sees. Unfortunately more big fish will not thoughtlessly risk his carcass, but every beast is greedy for food. Most often, medium and small fish will come across, larger specimens may be disdainful. The second condition is a tenacious bottom, where the sinker will have something to cling to in order to achieve the effect of self-cutting.

How to form a symmetrical loop correctly?

Take a spool of fishing line and a measuring tool. It is recommended to use fluorocarbon as a material, but an ordinary braid will also do.
Measure exactly one meter. Focus on the distance from the elbow to the wrist, measure this length twice.
Attach one end to the other, and bring out the middle with your fingers. After that, form a loop at the inflection.
Knit a loop with medical weaving, for reliability.
After that, begin to form a twist, its length should be approximately 10 to 15 cm, at your discretion. What is it for? It adds rigidity, thereby minimizing the chance of throwing it over the main thread.
You can make your work easier by holding the loop in your teeth or throwing it over a pencil.
Bringing the formation of the twist to the border, tie it with the aforementioned knot.
Now take the thread from the other side, and thread the swivel onto the thread, then adjust it to the border with the twist.
Measure 10-15 cm from the anchor where the swivel is located and tie a medical weave there. Now the swivel is fixed inside the symmetrical loop.
Next, tie the two ends into one and form a loop.

After carrying out all of the above actions, it remains only to fix the feeder. If desired, choose a weight that is convenient for you, taking into account complementary foods. Please note that factors such as bottom texture, current strength, and even turbidity of the water can affect the effectiveness of the weight. Take them into account when thinking about choosing weights. It is recommended to have a pair of feeders with a difference of several tens of grams.

Asymmetrical loop

Another application of the surgical knot in fishing will be an asymmetric loop (Figure 4).

In this case, your prey is a cautious inhabitant. fresh water. The advantage of the asymmetric loop and its main difference from the symmetrical one is the absence of a sense of load when swallowing the bait. The fish will not feel the load until it is too late, therefore, they will not suspect a dirty trick and will peck more willingly.

Figure 4. Asymmetrical loop is great for catching cautious freshwater fish

This is achieved precisely due to the asymmetry of the garter, because all the weight goes into the feeder. An additional advantage will also be increased stability of the tackle. Any vibrations, interference and twitches will be damped against the feeder before reaching the hook. Thus, stealth will remain, and the fish will not suspect anything. For a full-fledged effect, it is recommended to use flurcarbon threads up to 0.30 mm inclusive. What for? Fluorcarbon has a good refractive index comparable to that of water.

Who is the main prey? Cautious fish of the trophy class, which even during the feeding period will not rush to the hook suspiciously moving in the darkness of the waters. An important point - this type of tackle is only suitable for bottom-feeding fish, not for active predators.
Main application? Rivers with fast and medium current. Also suitable for fishing in bad weather, wind and other natural disturbances.
Disadvantages? Your game is a large and wary fish capable of tearing loose nets.

Unfortunately, this is also a consumable material, so it is recommended to make such knitting with the expectation of a replacement, but without attaching it to the main fishing line. Tying a surgical knot at the control points of this gear will increase its reliability.

How to make?

Go through the points of making a symmetrical loop exactly until the moment the twist is formed and its honey garter. Weaving.
Put the swivel on one of the ends and bring it to the connection with the twist.
Now hook the feeder onto the swivel.
Pull it 2 cm away from the knot. Great, remember this position, as this is a critical point. Also take a close look at the base of the loop from the side of the twist. The gap between the knot where the loop for attaching the hook is located and the beginning of the feeder should be within 2 cm.
Without taking your eyes off the swivel, fix it in this segment with a second knot. Measure along the second segment 12-14 cm.
After fixing the swivel, form a loop at the opposite end.
The rig is ready.

Like its neighbor in symmetry, this loop has the tricky property of self-cutting. This is achieved due to the absence of tangible resistance. After swallowing the hook, it does not stretch, and the fish continues its movement.

The hook enters deeper into the flesh of the fish, and when it realizes what has happened, it makes a sharp jerk to the side. This is where the weight of the feeder comes into play, representing an obstacle that gives the hook the opportunity to go even deeper and finally hook on the fish.

Rig Gardner

Light, simple, unpretentious. It was created by the talented angler Steve Gardner when he thought of a way to simplify feeder fishing to avoid long sessions of weaving gear. Suitable for both beginners and experienced fishermen. It has exceptional sensitivity, which is due to the simplicity of the design, but whether it can compete with an asymmetric loop is a moot point. The main advantage is that the texture of the bottom does not affect the effectiveness of the tackle, even if the feeder is drowned in unsteady silt, the fish can still be felt (Figure 5).

Figure 5. Gardner rig can greatly simplify the process of fishing

Who is the main prey? Any type peaceful fish regardless of discretion. But versatility comes at a cost.

Application area? Ideal when the bottom texture leaves much to be desired and other tackle does not work. Designed for flowing river water. This is a simple variation of the feeder sling with minimal movement.

How to weave it?

Get a bobbin of your monofilament.
Rewind about 50-60 cm.
Form a surgical knot on the fishing line with a long loop of 10 cm.
After that, thread the swivel on the clasp through the loop. An alternative is to place a swivel in the loop before tying it.
Attach the feeder to the mounting.
Now lift the montage, holding it by the loop plexus.
Take the remaining end, take a closer look.
The gap from the end of the feeder to the beginning of the fastening loop in the remaining part of the thread should be 2 cm, with an error of 1 cm.
Having measured the distance, start knitting a medical loop.
Installation is ready.

Exist various ways implementation of this equipment. Some suggest attaching the entire equipment to the swivel, making it removable. But this will visually clutter up the design, which will reduce its effectiveness against attentive and shy fish.

Varieties of surgical knots

We pass from theory to practice. Consider how to properly braid various types of surgical knots. There will be three in total.

Simple

There are three different kind techniques of surgical knots, among which is a simple one. Also, this plexus is known as female. But its main name is a simple surgical knot, and the main purpose is to teach the knitting process (Figure 6).

It is woven like this:

At the place of fastening, we twist the two ends once.
After that, we form a loop with the help of tails, as for tying a regular bundle.
We tighten.

Figure 6. Scheme of knitting a simple surgical loop

Now try to untie this bunch. She does not hold her ligature well, but it is suitable for quickly fastening something for 10 minutes.

Nautical

A more durable version of the previous weave is called a marine surgical knot. It is relatively more reliable, but still has its drawbacks (Figure 7).

How to knit this surgical knot?

As you can already understand, this is a complication of a simple variation.
According to technology, it is necessary to twist the ends twice, but for greater strength, do this three times.
Make a ring, tighten the ends - the knot is ready.

Figure 7. Marine variety is characterized by increased strength

This bundle will be much stronger than its predecessor, try to untie it yourself.

Complex

It is called complex for the increase in the number of loops formed. More than one, usually two or even three - the design of the fishing surgical knot is flexible. Physically more voluminous than its counterparts, just by increasing the number of loops.

It knits like this:

For the convenient implementation of this tie, it is necessary to measure the ends with a margin.
We recall the moment of knitting a loop on a marine bundle.
From the ends remaining after the first loop, form another loop.
If there is enough length - make the third one, it has a locking purpose.
For a completely dead fastening, you can throw another loop.

An attempt to untie a surgical knot of this level will not be successful, but if you get used to it, you can spend a couple of evenings on it. After casting more than two loops, it is not recommended to mess around with the decoupling of this fastening, so just cut it off.

Surgical Knot Knitting Technique

Great, you've mastered three basic principles, on which this interlacing is based. Now let's move on to its modifications for specific needs. There will be two of them, and they have different purposes.

How to tie a knot for a feeder? Of course, you are interested in a loop (Figure 8).

It is necessary for the implementation of loop-loop fastening in removable installations:

Start simple. Take a spool of regular thread.
Cut yourself a piece about the length of your palm.
Take the end, measure three phalanges of your finger and fold it in half in this place.
You have a coiled thread in your hands, excellent. Now pull it a little in the intended place of attachment of the ligament.
Grab the end of the fold, form a loop, and thread the fold through it twice.
Tighten. You should get a loop with a plump mount at the base.

Figure 8. Stages of knitting a loop for a feeder

If you are making loopless rigs tied to the main line, the procedure will be slightly different.

For fishing, the scheme of the surgical plexus will be as follows:

Lay the ends to be tied together.
Take a margin of 5 cm in each direction.
Stretch the ligament.
Form a ring into which the two ends of the loop should fall on one side - the leading and the driven.
Tighten the knot gradually.
Now try to stretch the ends in different directions. If they untie, then somewhere you made a mistake.
Repeat the process until a strong bond is obtained.

Scheme of connecting two fishing lines of different diameters

It just so happened that you have on hand samples of two lines of different diameters, which must be combined into one. This can be done in several ways. For example, a surgical knot for fishing on a feeder will not be fundamentally different from those described above, but there are more complex modifications of it, designed to strengthen the connection between two fishing lines (Figure 9).

Let's move on to the obvious, and complicate the situation as the story progresses:

We take the ends of the two woods that need to be tied.
We bend with a margin of length in two fingers.
Now interlace the end of the fastening thread of a smaller diameter with a larger fishing line.
Do this on both sides of the fold of the thick line. Weave at least three times on each side.
Then tighten the loop. You've created an academic knot weave known for its strength.

Figure 9. Using a surgical knot, you can tie two fishing lines

A more complex version of the double surgical knot is the griner. It is used to fasten hooks.

You will need to do the following:

Weave the two ends of the fishing line, make at least 3 windings with each end.
Lightly pinching the tips, make a hole in one of the middle turns.
Pull the ends through the loop formed.
Tighten and trim the ends.

Great, you have completed the Griner knot for attaching two different lines. It has a high rate of strength and stability, but the number of revolutions directly affects its reliability. Focus on a minimum of two, a maximum of five. Avoid over-thickening the ligament, as this can make your tackle unnecessarily bulky.

We tie two threads with a simple surgical knot

Practice, practice and more practice. Before you learn how to quickly connect everything that catches your eye, you need to try yourself on something simple. You probably just want to securely tie a loop on your sewing needle, but the standard methods do not suit you. In this case, the simple marine described above will suit you, it will be enough for sewing.

Let's look at how surgical knots are knitted to connect two different threads:

Essentially, the design will not differ from the previously described options. However, for different threads, it is recommended to use more complex curls.
Use fasteners with a parallel orientation of the threads under the loop.
It is recommended to tie with such weaving only ropes with a dense texture, i.e. fastening does not hold knitting for a long time or under loads.

Possible mistakes

When knitting knots, you can often encounter errors, and, as a result, with non-working weaving. The main error is not tightly tightened ligament. Wetting is not considered necessary, but for a stronger weave, it is still recommended to tighten it when wet.

The use of beads that stop the fishing line on surgical knots is not recommended. Since the main purpose of the feeder installation is secrecy, the beads will only interfere and disturb the fish with their presence. Knowing how to knit surgical knots for the feeder correctly, you will never be left without a bite.

One of the options for such a node is shown in the video.

The knots that anglers use to knit various elements of equipment, one way or another, are borrowed from other areas of human activity.

A lot of fishing knots “came” to fishing from mountaineering, some were borrowed from sailors. In this material, we will talk about the nodes that surgeons use in their work. Actually, they were called that: surgical.

Interestingly, these knots are also widely used in maritime affairs. Sailors traditionally call them surgical.

But surgeons who use these knots to tie the ends of medical threads call the knots “marine”. Here is such a pun.

Anglers use the terminology of sailors, so if in any article on making rigs you read a recommendation to use a surgical knot, then this term means the method of tying suggested below.

But before moving directly to the scheme itself, I want to say a few words about why anglers “borrowed” these knots from surgeons.

Suture materials used in surgical practice are very slippery, therefore they tend to spontaneously untie, which is completely unacceptable. Therefore, all nodes used by surgeons are highly reliable.

Monofilaments used by anglers are almost identical in their properties to most suture materials. Therefore, anglers quickly figured out how to use surgical knots in their needs.

Personally, I believe that some angler working as a surgeon knitted rigs using knots, which are traditional for his profession. Maybe even because I simply did not know any others :).

Comrades saw. We tried it, appreciated it, told other anglers. Ultimately, the surgical knot has become one of the most popular and in demand.

How to connect two fishing lines of different diameters?

In fishing practice, there is often a need to tie together two fishing lines of different diameters. Most often, the need arises when a leash or undergrowth needs to be tied to the main line.

Not all nodes used to connect the fishing lines allow you to securely fasten two monofilaments of different thicknesses. But the surgical knot just the same provides a reliable grip.

The step-by-step linking scheme is as follows:

Everything, the leash and the main line are securely connected to each other. I draw your attention to the fact that it is impossible (more precisely, theoretically possible, but practically extremely problematic) to tie a broken fishing line with this knot.

It is suitable only for tying short leashes and undergrowth, because during the knitting process it is necessary to pass the entire leash through the loop several times.

Surgical snare

The knot to which this article is devoted, you can tie not only the leash and the main fishing line. With a surgical knot, you can tie end loops, which are so often necessary for feeders to make asymmetrical and symmetrical loops.

The surgical loop is knitted very quickly and simply:

A loop tied in this way will never be untied. The surgical knot itself practically does not lose strength, which is also important.

Well, your storehouse of knowledge has been replenished with two more wonderful knots. The knots are very simple, having trained, they can be tied in a matter of seconds.

By the way, I read somewhere that surgeons can tie these knots with one hand. Maybe in time you will be able to.