We will continue our foray into the history of medicine with a giant leap back in time to the earliest evidence of surgical sutures and a brief overview of their evolution.
“In an era of ever-increasing surgical technology,” writes John Kirkup (a celebrated British orthopaedic surgeon who was concerned with the history and evolution of operative techniques and surgical instruments), “there is a tendency to minimise the importance of wound closure technique compared to the rest of the apparently much more sophisticated operative skills.”.
Indeed, before antiseptic and aseptic procedures were established – suturing being an important method of asepsis – the lack of wound suturing was a major cause of surgical failure.
Even today, with the whole arsenal of antiseptic substances, the success of the operation also depends on the appropriate suturing technique for good healing (at the level of skin, intestines, bones, tendons and other tissues) as well as for a proper aesthetic effect.
Today, a surgical suture typically consists of a needle of varying sizes, attached to a length of thread, used to join the edges of a wound or surgical incision. However, throughout history, suturing has been different. Needles were made from bone or metal and threads from silk or catgut (most often obtained from the intestines of sheep or even cats – Beclard – 1916).
Sometimes, a type of large ant was used to nip the wound tissue, leaving behind the head and pincers, achieving haemostasis and scarring.
Ancient Greeks, as well as the Chinese, used threads made from animal tendons, with the earliest evidence dating back to approximately 3000 BC. In antiquity, the physician Galenus (2nd century AD), who lived and practised in both Greece and Rome (where he was also Emperor Marcus Aurelius' physician), used various animal-derived materials for sutures, as did the great Arab surgeon Al-Zahrawi (10th-11th century AD – considered one of the founders of modern surgery).
In the 19th century, surgeons even preferred to cauterise (burn) wounds, an often gruesome process, to prevent patients from dying from infected injuries. The British surgeon Joseph Lister searched for and experimented with ways to sterilise catgut.
Today, many sutures are made from absorbable or non-absorbable polymer synthetic fibres, pre-mounted on “needles” without “eyes” so as to be atraumatic. Adhesives are also used to approximate (stick together) wounds.
Depending on their use, suture threads vary in thickness and must also meet various requirements (durability, elasticity, strength, non-toxicity, non-allergenicity, etc.), sometimes having a smaller diameter than a human hair.
During my student years, sutures were performed on facial skin in the Maxillofacial Surgery Clinic, Târgu-Mureș, using horsehair sutures. I also used similar sutures in the early years of my surgical practice at the Municipal Hospital in Galați, a disadvantage being the cumbersome sterilization. As a funny curiosity, only tail hairs from stallions were used; those from mares became degraded (became brittle – meaning they broke easily) due to urine absorption.
- article written by Dr Ionel Julea for reperemedicale.ro