From Big Medical Encyclopedia

LIGATURE (Latin. ligatura bandaging) — the thread tied around circulatory, absorbent vessel, a channel of a gall bladder, uterine tubes, an ureter etc. and left in a wound.

The stop of bleeding binding of vessels was offered by A. Tsels (apprx. 25 BC and 50 AD).

Fig. 1. Diagrammatic representation of alloyed nodes: 1 — surgical; 2 — sea; 3 — women's.
Fig. 2. Diagrammatic representation of bandaging of vessels: 1 — the ligature is imposed on an otpreparirovanny vessel; 2 — the ligature is imposed on a vessel by underrunning of surrounding fabrics.
Fig. 3. Diagrammatic representation of alloyed fistula: 1 — alloyed fistula with the acting thread; 2 — alloyed fistula in cross section.

Material for L. usually soft suture material serves: silk, catgut (see), capron, nylon, etc. In 18 century as L. applied a metal wire. During the imposing of L. the vascular wall in this site is injured, especially its internal cover, edges is broken off and wrapped inside that promotes formation of blood clot. L. it can be tied by a node of three types: surgical, sea, women's. The surgical node (fig. 1,2) forms by double twisting of the first loop. The second loop twists in the opposite direction. During the imposing of a sea node (fig. 1,2) the ends of threads in the first and second loop are spent in opposite directions. The female node (fig. 1,5) is tied by carrying out the ends of threads in both loops in the same direction. During the imposing of L. the blood vessel is previously allocated from surrounding fabrics by preparation that is especially necessary during the bandaging of large vessels. The allocated vessel is taken krovoostanavlivayushch a shchy .zazhim and tie up (fig. 2,1). During the setting of L. and tightening of a loop of a node index fingers should be held as it is possible closer to a node; at the same time in order to avoid a rupture of L. the first loop is tightened rather hardly, the second — is slightly weaker. When allocation of a vessel is complicated, he is captured a clip and tied up by underrunning of L. surrounding fabrics (fig. 2,2); L. tighten with a sufficient force for full overlapping of a gleam of a vessel, and in need of the same site the second is imposed, additional by L. To avoid sliding of L., it is not necessary to take in it the considerable mass of fabrics. Small vessels tie up with surrounding cellulose. Large vessels tie up silk, twisted linen fiber, capron or lavsan, tying them a surgical or sea node. The female node is unreliable and is applied only during the bandaging of small vessels. Silk and linen threads are cut off shortly: length of the ends is 4 — 5 mm. During the cutting of kapron and catgut thread the ends are left 1 cm long and more. Catgut thread in the first hours after operation bulks up, its nodes tend to unleashing that can lead to secondary bleeding. Shortly cut off ends of kapron thread stretched during the setting owing to high elasticity then are reduced and can escape from a node, having caused its unleashing. For the prevention of a similar complication of L. from a catgut and capron give up a surgical node addition of the third loop on a node. At infection of alloyed threads around them the granuloma with the subsequent development of a paraalloyed abscess and alloyed fistulas (fig. 3) is formed. Alloyed fistulas are liquidated only after removal of a ligature. Suppuration around L. it is characterized by a long and persistent current and can end with a spontaneous otkhozhdeniye of L. through fistula; sometimes its removal is required. In unsuccessful attempt to remove L. through fistula tweezers or a clip removal is necessary in its operational way.

Technique of imposing of L. on other educations (channels, ureters, etc.) and complications are identical. Thus more often on a stump of a channel impose piercing L.

Bibliography: Ballyuzek F. V., etc. A suture material from synthetic monothreads, Voyen. - medical zhurn., No. 4, page 33, 1976; Burenin P. I. idr. Linen threads for surgical practice, Vestn. hir., t. 112, No. 3, page 75, 1974; New surgical devices and tools and experience of their use, under red M. G. Ananyeva, century 2, page 7, M., 1958; Smirnova., To r and at to l and with Yu. K. and P l about t to and L. L N. Fabric reaction to an antimicrobic suture material, Voyen. - medical zhurn., No. 12, page 68, 1976; V. I Pods. General surgery, M., 1978; Postlethwait R. W., Willigan D. A. a. Ulin A. W. Human tissue reaction to sutures, Ann. Surg., v. 181, p. 144, 1975.

M. A.-V. Galeyev.