Suturing (Stitching) 3000 BC – Still Essential to Medicine

Historical figures mentioned in the article: Galen of Pergamon (129–199), al-Zahrawi (936–1013), Joseph Lister (1827–1912)

Surgeon John Kirkup writes, “In an age of increasing surgical technology, it is tempting to downgrade the minor technique of wound closure compared with more sophisticated operative skills. Indeed, before antiseptic and aseptic procedures existed, closing a wound was the source of many disasters. Even today, successful operations depend on the rapid and reliable healing of skin, bowel, bone, tendon and other tissues, and a scar that is acceptable either therapeutically or cosmetically cannot be guaranteed."

Today, a surgical suture generally refers to a needle that is a thread of a certain length and varying construction, used to stitch together the edges of a wound or surgical incision. Throughout history, however, suturing has taken many forms. Needles were made of bone or metal. Sutures were made from materials such as silk or catgut (sheep intestines). Large ants were also sometimes used to clamp wounds. After the ant's pincers bit into the flesh and closed an opening, its body was removed, leaving only the head and closed pincers. Ancient Egyptians used linen and animal sinuses to close wounds, and the first reports of such sutures date back to the 3000s BC. The second-century Greco-Roman physician Galen used sutures made from animal materials, as did the Arab surgeon el-Zahrawi. British surgeon Joseph Lister investigated ways to sterilize catgut, a suture material that the body gradually absorbs. In the 1930s, a major catgut suture manufacturer used 26,000 sheep intestines in a single day. Today, many sutures are made from absorbable or non-absorbable synthetic polymer fibres, and eyeless needles can be pre-attached to the suture to reduce trauma to body tissues during threading. Adhesive liquids are also used to help close wounds.

Suture widths can vary according to their use, and some are smaller than the diameter of a human hair. In the nineteenth century, rather than risk patients dying from infected sutures, surgeons preferred to cauterize wounds (sear or burn them), often a horrifying procedure.

Description of the article image: A surgeon's gloved hand holds a needle holder with an atraumatic curved cutting needle attached to a 4-0 monofilament non-absorbable synthetic suture.

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