Health Care

Hilton Head Island knot enthusiast proves old sailing method best for surgeons

Hilton Head Island resident and retired anesthesiologist Alan Grogono sits in his garage at the Wexford Plantation on March 20, 2014.
Hilton Head Island resident and retired anesthesiologist Alan Grogono sits in his garage at the Wexford Plantation on March 20, 2014. Staff photo

An inventor and innovator, Alan Grogono is the kind of person who's always creating something.

Growing up in England during World War II, he and his brothers would search for unexploded bombs, unscrew the detonators and bring home the casings to make fireworks. They were raised with a "do-it-yourself" mentality, encouraged to create the things they wanted.

Around his Hilton Head Island home are various contraptions the retired anesthesiologist has made over the years -- a mobile of all the compounds used by anesthesiologists with hidden motive power, an infinity box made of mirrors.

Up the stairs, though, is a world of knots. Fifteen years ago, Grogono created Animated Knots by Grog, a website devoted to tying knots, which sees upward of 20,000 visitors daily. The guest suite in his home has since been converted into a photo studio where he makes knot tutorials for surgical, sailing, climbing and fishing knots.

"You've got to be a retired idiot to put this sort of time into knots," Grogono said.

The website led Howard Taylor, a veterinary surgeon from England, to Grogono. Taylor sought to create a better knot to use when spaying a dog -- one that wouldn't slip, lessening the risk of internal bleeding. He enlisted Grogono's help.

Together, the two sought to prove that an old and trusted sailing knot is the best knot for surgeons to use to tie off a blood vessel. The study, "The Constrictor Knot is the Best Ligature," co-authored by Grogono and Taylor, was published in the March issue of "The Annals of the Royal College of Surgeons."

For the study, Grogono built a rig in his garage -- stationed between his golf cart and tool storage -- to compare six ligatures, or surgical knots, using four suture materials.

For the experiment, he tied a ligature around a steel bar, and then attached weights -- made of recycled water bottles and Publix orange juice containers, the caps numbered in Sharpie -- to the ends of the string. Grogono tightened the knot using a crank and calibrated the knot's grip on the steel bar.

Some knots gripped well, but when the weights on each end of the string were lifted, the knot became loose. As Grogono and Taylor had predicted, the constrictor knot showed the highest ligature tension after the weights were removed, meaning it was the strongest.

"We decided we had good results a surgeon could understand," Grogono said.

There hasn't been great response from surgeons so far, but Grogono expected as much.

"As yet I haven't had much feedback, and I'm prepared to be disappointed, to find that it hasn't had a huge impact on surgery," Grogono said.

He said part of the reason is that surgeons have moved on to using clips to tie off blood vessels more than knots. Another part, Grogono said, is that surgeons can be set in their ways, and he thinks the response may come from the next generation of surgeons.

"The dream that we're going to change their ways quickly isn't feasible," Grogono said. "I think (the response) may come from students who visit my website and say, 'Hey, that's interesting.' "

With all his knot ventures, the goal was never to make money, but "just for the pleasure of educating other people." As he was taught knots, he's passing that on to anyone who might need a lesson.

Grogono's knot education came from his father, who served as a doctor in the Navy. When he returned home from the war in 1945, he had a newfound passion for sailing and began teaching his sons the ways of the wind.

There, Grogono got his first lesson in knots -- tying sails on the boat, tying the boat onto the dock, attaching the rope onto the top of the sail, making an adjustable rope for holding the boom down, putting a knob on the end of the rope so it could be thrown ashore. He learned the square knot is OK for tying shoes, but really bad for joining two ropes together. He learned there's a better knot, called the sheet bend.

"It was enough to give me a general feel for my interest," Grogono said.

That interest continues today. Grogono will keep updating his knots website and wait for the next idea to excite him. Last year he completed another website, Animated Napkin Folds by Grog, and is thinking of doing one on paper airplanes as well.

"I am a passionate believer that in this life, an amateur can do a lot of what a professional can," Grogono said. "I never had any training in computing or running a website, but it's not a deep, dark secret.

"The idea is if you want something, do it yourself," Grogono said. "If you want to create things in this life, you can do it."

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