Wound Closure with Sutures: Today and in History
The role of stitches and sutures in transforming the field of medical surgery throughout history is undeniable. These medical devices are used for apposition of body tissues after injury and surgery, and have evolved over thousands of years from being fashioned out of organic materials to being manufactured using synthetic polymer fibres. Let’s trace the evolution of wound closure with modern-day sutures, such as Ethicon’s Stratafix suture, from their rudimentary beginnings in and around 30000 BC.
Fossilized remains of Neolithic skulls from 30000 BC point towards the first documented usage of eyed needles to tie wounds and for surgery. From then on, sutures gradually evolved into silk or catgut sutures. For needles, bone, silver and copper were widely used, while flax, hemp, cotton, animal hair, arteries, and tendons were used as sutures. Hippocrates, the Greek father of medicine, mentioned suture techniques in his works, while a detailed study of sutures was discovered in Indian physician Sushruta’s works around 500 BC. The Egyptians also used sutures to stitch the wounded and the mummies as well.
In 1876, British surgeon Sir Joseph Lister introduced the concept of sterilization of sutures which was a critical element in his promotion of antiseptic surgery. With this technique, the risk of infection during wound closure was eliminated. Made from catgut and silk, the first sterile sutures were later mass-produced beginning 1887. Thereafter, in 1920s and 1930s, eyeless needled sutures were developed by Scottish pharmacist George Merson. Synthetic and non-synthetic absorbable sutures were also developed around this time. By 1960, sterilization of sutures by irradiation made the manufacturing process even more rapid, and extensive development of polymer technology later on paved the way for modern-day sutures and innovative wound closure adhesives.
Modern day sutures are made from synthetic polymers. Also, unlike the composition of a regular 5 ml syringe with needle, the needles used in cardiovascular suturing, especially, are made from stronger metal alloys. The major characteristics of modern-day sutures used for wound closure are their pliability, tensile strength, breaking strength, and tissue reactivity. Depending upon the type of tissue being sewed together, different kinds of sutures and suturing techniques exist.
Majorly, sutures are classified on the basis of their absorbability by the body. Absorbable sutures get dissolved in the body and are used for short-term wound closure. When the requirement is to tie up tissue for a longer duration, non-absorbable sutures with prolonged tensile strength are used; monofilament sutures are easier to pass through tissues, and multifilament sutures work for robust knotting. Nowadays, knotless sutures, such as Stratafix sutures, are also becoming increasingly popular. Along with sutures, other popular modern methods of wound closure include butterfly stitches with adhesive tape, skin glue, staples, and laser tissue welding.