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A surgical suture, also known as a stitch or stitches, is a
medical device A medical device is any device intended to be used for medical purposes. Significant potential for hazards are inherent when using a device for medical purposes and thus medical devices must be proved safe and effective with reasonable assura ...
used to hold
body tissue In biology, tissue is a biological organizational level between cells and a complete organ. A tissue is an ensemble of similar cells and their extracellular matrix from the same origin that together carry out a specific function. Organs are ...
s together and approximate wound edges after an injury or surgery. Application generally involves using a needle with an attached length of thread. There are numerous types of suture which differ by needle shape and size as well as thread material and characteristics. Selection of surgical suture should be determined by the characteristics and location of the wound or the specific body tissues being approximated. In selecting the needle, thread, and suturing technique to use for a specific patient, a medical care provider must consider the
tensile strength Ultimate tensile strength (UTS), often shortened to tensile strength (TS), ultimate strength, or F_\text within equations, is the maximum stress that a material can withstand while being stretched or pulled before breaking. In brittle materials t ...
of the specific suture thread needed to efficiently hold the tissues together depending on the mechanical and shear forces acting on the wound as well as the thickness of the tissue being approximated. One must also consider the elasticity of the thread and ability to adapt to different tissues, as well as the memory of the thread material which lends to ease of use for the operator. Different suture characteristics lend way to differing degrees of tissue reaction and the operator must select a suture that minimizes the tissue reaction while still keeping with appropriate tensile strength.


Needles

Historically, surgeons used reusable needles with holes (called "eyes"), which are supplied separate from their suture thread. Such suture must be threaded on site, as is done in
embroidery Embroidery is the craft of decorating fabric or other materials using a needle to apply thread or yarn. Embroidery may also incorporate other materials such as pearls, beads, quills, and sequins. In modern days, embroidery is usually seen on c ...
sewing. The advantage of this is that any thread and needle combination is possible to suit the job at hand.
Swage Swaging () is a forging process in which the dimensions of an item are altered using dies into which the item is forced. Swaging is usually a cold working process, but also may be hot worked. The term swage may apply to the process (verb) or ...
d, or atraumatic, needles with sutures consist of a pre-packed eyeless needle attached to a specific length of suture thread. The suture manufacturer
swage Swaging () is a forging process in which the dimensions of an item are altered using dies into which the item is forced. Swaging is usually a cold working process, but also may be hot worked. The term swage may apply to the process (verb) or ...
s the suture thread to the eyeless atraumatic needle at the factory. The chief advantage of this is that the doctor or the nurse does not have to spend time threading the suture on the needle, which may be difficult for very fine needles and sutures. Also, the suture end of a swaged needle is narrower than the needle body, eliminating drag from the thread attachment site. In eyed needles, the thread protrudes from the needle body on both sides, and at best causes drag. When passing through friable tissues, the eye needle and suture combination may thus traumatise tissues more than a swaged needle, hence the designation of the latter as "atraumatic". There are several shapes of surgical needles. These include: * Straight * 1/4 circle * 3/8 circle * 1/2 circle. Subtypes of this needle shape include, from larger to smaller size, CT, CT-1, CT-2 and CT-3. * 5/8 circle * compound
curve In mathematics, a curve (also called a curved line in older texts) is an object similar to a line (geometry), line, but that does not have to be Linearity, straight. Intuitively, a curve may be thought of as the trace left by a moving point (ge ...
* half curved (also known as ski) * half curved at both ends of a straight segment (also known as canoe) The ski and canoe needle design allows curved needles to be straight enough to be used in
laparoscopic surgery Laparoscopy () is an operation performed in the abdomen or pelvis using small incisions (usually 0.5–1.5 cm) with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few small cuts in the abdomen.Medl ...
, where instruments are inserted into the abdominal cavity through narrow cannulas. Needles may also be classified by their point geometry; examples include: * taper (needle body is round and tapers smoothly to a point) * cutting (needle body is triangular and has a sharpened cutting edge on the inside curve) * reverse cutting (cutting edge on the outside) * trocar point or tapercut (needle body is round and tapered, but ends in a small triangular cutting point) * blunt points for sewing
friable Friability ( ), the condition of being friable, describes the tendency of a solid substance to break into smaller pieces under duress or contact, especially by rubbing. The opposite of friable is indurate. Substances that are designated hazardous, ...
tissues * side cutting or spatula points (flat on top and bottom with a cutting edge along the front to one side) for eye surgery Finally, atraumatic needles may be permanently swaged to the suture or may be designed to come off the suture with a sharp straight tug. These "pop-offs" are commonly used for interrupted sutures, where each suture is only passed once and then tied. Sutures can withstand different amounts of force based on their size; this is quantified by the U.S.P. Needles Pull Specifications.


Thread


Materials

Suture material is often broken down into absorbable thread versus non-absorbable thread, which is further delineated into synthetic fibers versus natural fibers. Another important distinction among suture material is whether it is monofilament or polyfilament (braided) Monofilament versus polyfilament: monofilament fibers have less tensile strength, but create less tissue trauma and are more appropriate with delicate tissues where tissue trauma can be more significant such as small blood vessels. Polyfilament (braided) sutures are composed of multiple fibers and are generally greater in diameter with greater tensile strength, however, they tend to have greater tissue reaction and theoretically have more propensity to harbor bacteria. Other properties to consider: * Tensile Strength: the ability of the suture to hold tissues in place without breaking. * Elasticity: the ability of the suture material to adapt to changing tissues such as in cases of edema. * Tissue reactivity: inflammatory response of the surrounding tissue that can cause materials to break down quicker and lose tensile strength. Non absorbable synthetic suture have the lowest of tissue reactivity, while the absorbable natural fibers have the highest rates of tissue reactivity. * Knot security: the ability of the suture to maintain a knot that holds the thread in place. Absorbable Absorbable sutures are either degraded via proteolysis or hydrolysis and should not be utilized on body tissue that would require greater than two months of tensile strength. It is generally used internally during surgery or to avoid further procedures for individuals with low likelihood of returning for suture removal. Natural absorbable: includes plain catgut, chromic catgut and fast catgut which are all produced from the collagen extracted from bovine intestines. They are all polyfilaments which have different degradations times ranging from 3–28 days. This material is often used for body tissue with low mechanical or shearing force and rapid healing time. Plain Gut – Polyfilament. * Description: Maintains original strength for 7–10 days and full degradation occurs in 10 weeks. * Advantages/disadvantages: Excellent elasticity allowing for adaptation to tissue swelling. Passes through the skin with very little tissue trauma occurrence. Poor handling and high tissue reactivity causing quick loss of tensile strength. * Common use: best used in rapidly healing tissues with good blood supply i.e. mucosal tissues. Chromic Gut – Polyfilament * Description: Maintains original strength for 21–28 days and full degradation occurs in 16–18 weeks. * Advantages/disadvantages: Excellent elasticity allowing for adaptation to tissue swelling. Passes through the skin with very little tissue trauma occurrence. Improved handling and decreased tissue reactivity due to chromic salt coating. * Common use: skin closure (face), mucosa, genitalia. Fast Gut – polyfilament * Description: Treated with heat to further break down protein and allow for more rapid absorption in bodily tissues. Tensile strength less than a week (3–5 days). * Advantages/disadvantages: Excellent elasticity allowing for adaptation to tissue swelling. Passes through the skin with very little tissue trauma occurrence. * Common use: Advised for skin closure only generally on the mucosa or face. Synthetic absorbable: includes Polyglactic acid, Polyglycolic acid, Poliglecaprone, Polydioxanone and Polytrimethylene carbonate. Among these are monofilaments, polyfilaments and braided sutures. In general synthetic materials will keep tensile strength for longer due to less local tissue inflammation. Poliglecaprone – monofilament (Monocryl, Monocryl Plus, Suruglyde) * Description: copolymer of synthetic materials. Loses tensile strength quickly; sixty percent lost in the first week. All strength lost within 3 weeks. * Advantages/disadvantages: high tensile strength, excellent elasticity, excellent cosmetic outcomes, decreased hypertrophic scarring, minimal tissue reaction, good knot security originally, however the material makes the security unreliable over time, thus it is important to keep ears of material long. * Common use: Advised for subcutaneous and superficial tissue closure. Polyglycolic Acid - polyfilament (Dexon) * Description: synthetic polymer that loses all tensile strength in by 25 days. Either dyed green for visibility or undyed. * Advantages/disadvantages: minimal tissue reaction, good tensile strength, good handling, but poor knot security. * Common use: subcutaneous tissue. Polyglactin 910 - polyfilament (Vicryl) * Description: loss of all tensile strength in 28 days. * Advantages/disadvantages: minimal tissue reaction, good tensile strength, good knot security, * Common use: subcutaneous tissue, skin closure (avoid dyed Vicryl on face), Polyglactin 910 Irradiated - polyfilament (Vicryl Rapid) * Description: sourced as vicryl is with irradiation to break down material for quicker absorption. Loss of all tensile strength in 5–7 days. * Advantages/disadvantages: minimal tissue reaction, good tensile strength, fair good handling and good knot security. * Common use: scalp and facial laceration closure. Polglyconate - monofilament (Maxon) * Description: co polymer product of synthetic materials. Loses 75% of the tensile strength after 40 days. * Advantages/disadvantages: minimal tissue reaction, excellent tensile strength, good handling. * Common use: subcutaneous use often an alternative to PDS due to better handling and slightly superior tensile strength. Polydioxanone Closures (PDS) - monofilament * Description: loss of tensile strength in 36–53 days. * Advantages/disadvantages: minimal tissue reaction, good tensile strength, but poor handling. * Common use: subcutaneous with need of high tensile strength (abdominal incision closure). Non-absorbable These sutures hold greater tensile strength for longer periods of time and are not subject to degradation. They are appropriate for tissues with a high degree of mechanical or shear force (tendons, certain skin location). They also supply the operator with greater ease of use due to less thread memory. Natural: Silk - polyfilament (Permahand, Ethicon; Sofsilk, Covidien) * Description: surgical silk is a protein derived from silkworms that is coated to minimize friction and water absorption. * Advantages/disadvantages: This material has good tensile strength, is easy to handle and has excellent knot security. However, it is rarely used internally due to its significant tissue reaction which causes loss of tensile strength over months. * Common use: Due to advancements in sutures, there is no longer indication for use of surgical silk. However, it is still commonly used in dentistry for mucosal surfaces or to secure surgical tubes on the bodies surface. Synthetic: includes nylon, polypropylene and surgical steel all of which are monofilaments with great tensile strength. Nylon - monofilaments (Dermalon, Ethilon) * Description: polyamide * Advantages/disadvantages: Excellent tensile strength. However, poor handling and poor knot security due to high material memory. * Common use: Excellent for superficial skin closure due to minimal tissue reactivity. It is the most commonly used skin suture due to its excellent adaptability to potentially expanding tissues (edema). Nylon - polyfilaments (Nurolon, Surgilon, Supramid) * Description: polyamide * Advantages/disadvantages: Excellent tensile strength, increased usability, and increased knot security as compared to its monofilamentous counterpart. However, it's polyfilamentous characteristics is said to increase risk of infection. * Common use: soft tissue, vessel ligations and superficial skin (specifically facial lacerations). Braided Polyester – polyfilament (Ethibond, Dagrofil, Synthofil, PremiCron, Synthofil) * Description: made from polyethylene terephthalate, there are various brands and configurations of this type of suture. Many are braided, coated in silicone and dyed for visibility. * Advantages/disadvantages: Good handling, good knot security and high tensile strength due to low tissue reactivity. However, this suture can create more tissue trauma when passing through the skin and is more expensive than its counterparts * Common use: Rare, pediatric valvular surgery, alternative to surgical steel for orthopedic surgery due to superior handling. Polybutester – monofilament (Novafil) * Description: A copolymer of polyester. * Advantages/disadvantages: low tissue reactivity, good handling, high tensile strength that is greater than most other monofilaments, good elasticity during increasing edema. * Common use: rare, tendon repairs, plastics (pull out subcuticular stitch) Surgical Steel * Description: synthetic mixture of multiple alloys. * Advantages/disadvantages: Tensile strength is exceptional with very little tissue reactivity, thus maintaining minimal degradation over time. Unfortunately, this suture material has very poor handling. * Common use: orthopedics, sternum closure.


Sizes

Suture sizes are defined by the
United States Pharmacopeia The ''United States Pharmacopeia'' (''USP'') is a pharmacopeia (compendium of drug information) for the United States published annually by the United States Pharmacopeial Convention (usually also called the USP), a nonprofit organization that ...
(U.S.P.). Sutures were originally manufactured ranging in size from #1 to #6, with #1 being the smallest. A #4 suture would be roughly the diameter of a tennis racquet string. The manufacturing techniques, derived at the beginning from the production of musical strings, did not allow thinner diameters. As the procedures improved, #0 was added to the suture diameters, and later, thinner and thinner threads were manufactured, which were identified as #00 (#2-0 or #2/0) to #000000 (#6-0 or #6/0). Modern sutures range from #5 (heavy braided suture for orthopedics) to #11-0 (fine monofilament suture for ophthalmics). Atraumatic needles are manufactured in all shapes for most sizes. The actual diameter of thread for a given U.S.P. size differs depending on the suture material class. :


Techniques

Many different techniques exist. The most common is the
simple interrupted stitch The simple interrupted stitch is a suturing technique used to close wounds. It is the most commonly used technique in the closure of skin. It is known as an interrupted stitch because the individual stitches aren't connected; they are separate. Pl ...
; it is indeed the simplest to perform and is called "interrupted" because the suture thread is cut between each individual stitch. The
vertical Vertical is a geometric term of location which may refer to: * Vertical direction, the direction aligned with the direction of the force of gravity, up or down * Vertical (angles), a pair of angles opposite each other, formed by two intersecting s ...
and
horizontal mattress stitch The horizontal mattress stitch is a suture technique used to close wounds. It everts skin well and spreads tension along the wound edge. This makes it ideal for holding together fragile skin as well as skin under high tension such as the distant e ...
are also interrupted but are more complex and specialized for everting the skin and distributing tension. The running or continuous stitch is quicker but risks failing if the suture is cut in just one place; the continuous locking stitch is in some ways a more secure version. The
chest drain stitch A chest tube (also chest drain, thoracic catheter, tube thoracostomy or intercostal drain) is a surgical drain that is inserted through the chest wall and into the pleural space or the mediastinum in order to remove clinically undesired substances ...
and
corner stitch The corner stitch is a common suture technique. It used to close wounds that are angled or Y-shaped without appreciably compromising blood supply to the wound tip. The corner stitch is a variation of the horizontal mattress stitch, and is sometime ...
are variations of the horizontal mattress. Other stitches or suturing techniques include: * ''Purse-string suture'', a continuous, circular inverting suture which is made to secure apposition of the edges of a surgical or traumatic wound. * Figure-of-eight stitch * Subcuticular stitch. A continuous suture where the needle enters and exits the epidermis along the plane of the skin. This stitch is for approximating superficial skin edges and provides the best cosmetic result. Superficial gapping wounds may be reduced effectively by using continuous subcuticular sutures. It is unclear whether subcuticular sutures can reduce the rate of surgical site infections.when compared with other suturing methods.


Placement

Sutures are placed by mounting a needle with attached suture into a
needle holder A needle holder, also called needle driver or needle forceps, is a surgical instrument similar to a hemostat, used by doctors and surgeons to hold and push a suturing needle when performing wound closure, ligation and other surgical procedures t ...
. The needle point is pressed into the flesh, advanced along the trajectory of the needle's curve until it emerges, and pulled through. The trailing thread is then tied into a knot, usually a square knot or
surgeon's knot The surgeon's knot is a surgical knot and is a simple modification to the reef knot. It adds an extra twist when tying the first throw, forming a double overhand knot. The additional turn provides more friction and can reduce loosening while th ...
. Ideally, sutures bring together the wound edges, without causing indenting or blanching of the skin, since the blood supply may be impeded and thus increase
infection An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...
and scarring. Ideally, sutured skin rolls slightly outward from the wound (eversion), and the depth and width of the sutured flesh is roughly equal. Placement varies based on the location,


Stitching interval and spacing

Skin and other
soft tissue Soft tissue is all the tissue in the body that is not hardened by the processes of ossification or calcification such as bones and teeth. Soft tissue connects, surrounds or supports internal organs and bones, and includes muscle, tendons, ligam ...
can lengthen significantly under strain. To accommodate this lengthening, continuous stitches must have an adequate amount of slack. Jenkin's rule was the first research result in this area, showing that the then-typical use of a suture-length to wound-length ratio of 2:1 increased the risk of a burst wound, and suggesting a SL:WL ratio of 4:1 or more in abdominal wounds. A later study suggested 6:1 as the optimal ratio in abdominal closure.


Layers

In contrast to ''single layer suturing'', ''two layer suturing'' generally involves suturing at a deeper level of a tissue followed by another layer of suturing at a more superficial level. For example,
Cesarean section Caesarean section, also known as C-section or caesarean delivery, is the surgical procedure by which one or more babies are delivered through an incision in the mother's abdomen, often performed because vaginal delivery would put the baby or mo ...
can be performed with single or double layer suturing of the uterine incision.


Removal

Whereas some sutures are intended to be permanent, and others in specialized cases may be kept in place for an extended period of many weeks, as a rule sutures are a short-term device to allow healing of a trauma or wound. Removal of sutures is traditionally achieved by using forceps to hold the suture thread steady and pointed scalpel blades or scissors to cut. For practical reasons the two instruments (forceps and scissors) are available in a sterile kit. In certain countries (e.g. US), these kits are available in sterile disposable trays because of the high cost of cleaning and re-sterilization.


Expansions

A ''pledgeted suture'' is one that is supported by a ''pledget'', that is, a small flat non-absorbent pad normally composed of
polytetrafluoroethylene Polytetrafluoroethylene (PTFE) is a synthetic fluoropolymer of tetrafluoroethylene that has numerous applications. It is one of the best-known and widely applied PFAS. The commonly known brand name of PTFE-based composition is Teflon by Chemour ...
, used as buttresses under sutures when there is a possibility of sutures tearing through tissue.


Tissue adhesives

Topical
cyanoacrylate Cyanoacrylates are a family of strong fast-acting adhesives with industrial, medical, and household uses. They are derived from ethyl cyanoacrylate and related esters. The cyanoacrylate group in the monomer rapidly polymerizes in the presence ...
adhesives (closely related to super glue), have been used in combination with, or as an alternative to, sutures in wound closure. The adhesive remains liquid until exposed to water or water-containing substances/tissue, after which it cures (polymerizes) and forms a bond to the underlying surface. The tissue adhesive has been shown to act as a barrier to microbial penetration as long as the adhesive film remains intact. Limitations of tissue adhesives include contraindications to use near the eyes and a mild learning curve on correct usage. They are also unsuitable for oozing or potentially contaminated wounds. In surgical incisions it does not work as well as sutures as the wounds often break open. Cyanoacrylate is the generic name for cyanoacrylate based fast-acting glues such as methyl-2-cyanoacrylate, ethyl-2-cyanoacrylate (commonly sold under trade names like Superglue and Krazy Glue) and n-butyl-cyanoacrylate. Skin glues like Indermil and Histoacryl were the first medical grade tissue adhesives to be used, and these are composed of n-butyl cyanoacrylate. These worked well but had the disadvantage of having to be stored in the refrigerator, were exothermic so they stung the patient, and the bond was brittle. Nowadays, the longer chain polymer, 2-octyl cyanoacrylate, is the preferred medical grade glue. It is available under various trade names, such as LiquiBand, SurgiSeal, FloraSeal, and Dermabond. These have the advantages of being more flexible, making a stronger bond, and being easier to use. The longer side chain types, for example octyl and butyl forms, also reduce tissue reaction.


History

Through many millennia, various suture materials were used or proposed. Needles were made of
bone A bone is a Stiffness, rigid Organ (biology), organ that constitutes part of the skeleton in most vertebrate animals. Bones protect the various other organs of the body, produce red blood cell, red and white blood cells, store minerals, provid ...
or metals such as
silver Silver is a chemical element with the Symbol (chemistry), symbol Ag (from the Latin ', derived from the Proto-Indo-European wikt:Reconstruction:Proto-Indo-European/h₂erǵ-, ''h₂erǵ'': "shiny" or "white") and atomic number 47. A soft, whi ...
,
copper Copper is a chemical element with the symbol Cu (from la, cuprum) and atomic number 29. It is a soft, malleable, and ductile metal with very high thermal and electrical conductivity. A freshly exposed surface of pure copper has a pinkis ...
, and
aluminium Aluminium (aluminum in American and Canadian English) is a chemical element with the symbol Al and atomic number 13. Aluminium has a density lower than those of other common metals, at approximately one third that of steel. I ...
bronze Bronze is an alloy consisting primarily of copper, commonly with about 12–12.5% tin and often with the addition of other metals (including aluminium, manganese, nickel, or zinc) and sometimes non-metals, such as phosphorus, or metalloids such ...
wire Overhead power cabling. The conductor consists of seven strands of steel (centre, high tensile strength), surrounded by four outer layers of aluminium (high conductivity). Sample diameter 40 mm A wire is a flexible strand of metal. Wire is c ...
. Sutures were made of plant materials (
flax Flax, also known as common flax or linseed, is a flowering plant, ''Linum usitatissimum'', in the family Linaceae. It is cultivated as a food and fiber crop in regions of the world with temperate climates. Textiles made from flax are known in ...
,
hemp Hemp, or industrial hemp, is a botanical class of ''Cannabis sativa'' cultivars grown specifically for industrial or medicinal use. It can be used to make a wide range of products. Along with bamboo, hemp is among the fastest growing plants o ...
and
cotton Cotton is a soft, fluffy staple fiber that grows in a boll, or protective case, around the seeds of the cotton plants of the genus ''Gossypium'' in the mallow family Malvaceae. The fiber is almost pure cellulose, and can contain minor perce ...
) or animal material (
hair Hair is a protein filament that grows from follicles found in the dermis. Hair is one of the defining characteristics of mammals. The human body, apart from areas of glabrous skin, is covered in follicles which produce thick terminal and f ...
,
tendons A tendon or sinew is a tough, high-tensile-strength band of dense fibrous connective tissue that connects muscle to bone. It is able to transmit the mechanical forces of muscle contraction to the skeletal system without sacrificing its ability ...
,
arteries An artery (plural arteries) () is a blood vessel in humans and most animals that takes blood away from the heart to one or more parts of the body (tissues, lungs, brain etc.). Most arteries carry oxygenated blood; the two exceptions are the pul ...
,
muscle Skeletal muscles (commonly referred to as muscles) are organs of the vertebrate muscular system and typically are attached by tendons to bones of a skeleton. The muscle cells of skeletal muscles are much longer than in the other types of muscl ...
strips and
nerves A nerve is an enclosed, cable-like bundle of nerve fibers (called axons) in the peripheral nervous system. A nerve transmits electrical impulses. It is the basic unit of the peripheral nervous system. A nerve provides a common pathway for the e ...
,
silk Silk is a natural protein fiber, some forms of which can be woven into textiles. The protein fiber of silk is composed mainly of fibroin and is produced by certain insect larvae to form cocoons. The best-known silk is obtained from the coc ...
, and
catgut Catgut (also known as gut) is a type of cord that is prepared from the natural fiber found in the walls of animal Gut (anatomy), intestines. Catgut makers usually use sheep or goat intestines, but occasionally use the intestines of cattle, Domest ...
). The earliest reports of surgical suture date to 3000 BC in ancient
Egypt Egypt ( ar, مصر , ), officially the Arab Republic of Egypt, is a transcontinental country spanning the northeast corner of Africa and southwest corner of Asia via a land bridge formed by the Sinai Peninsula. It is bordered by the Mediter ...
, and the oldest known suture is in a
mummy A mummy is a dead human or an animal whose soft tissues and organs have been preserved by either intentional or accidental exposure to chemicals, extreme cold, very low humidity, or lack of air, so that the recovered body does not decay fu ...
from 1100 BC. A detailed description of a wound suture and the suture materials used in it is by the Indian sage and physician
Sushruta Sushruta, or ''Suśruta'' (Sanskrit: सुश्रुत, IAST: , ) was an ancient Indian physician. The ''Sushruta Samhita'' (''Sushruta's Compendium''), a treatise ascribed to him, is one of the most important surviving ancient treatises on ...
, written in 500 BC. The Greek father of medicine,
Hippocrates Hippocrates of Kos (; grc-gre, Ἱπποκράτης ὁ Κῷος, Hippokrátēs ho Kôios; ), also known as Hippocrates II, was a Greek physician of the classical period who is considered one of the most outstanding figures in the history of ...
, described suture techniques, as did the later Roman
Aulus Cornelius Celsus Aulus Cornelius Celsus ( 25 BC 50 AD) was a Roman encyclopaedist, known for his extant medical work, ''De Medicina'', which is believed to be the only surviving section of a much larger encyclopedia. The ''De Medicina'' is a primary source on d ...
. The 2nd-century Roman physician
Galen Aelius Galenus or Claudius Galenus ( el, Κλαύδιος Γαληνός; September 129 – c. AD 216), often Anglicized as Galen () or Galen of Pergamon, was a Greek physician, surgeon and philosopher in the Roman Empire. Considered to be one of ...
described sutures made of surgical gut or
catgut Catgut (also known as gut) is a type of cord that is prepared from the natural fiber found in the walls of animal Gut (anatomy), intestines. Catgut makers usually use sheep or goat intestines, but occasionally use the intestines of cattle, Domest ...
. In the 10th century, the
catgut suture Catgut suture is a type of surgical suture that is naturally degraded by the body's own proteolytic enzymes. Absorption is complete by 90 days, and full tensile strength remains for at least 7 days. This eventual disintegration makes it good for ...
along with the surgery needle were used in operations by
Abulcasis Abū al-Qāsim Khalaf ibn al-'Abbās al-Zahrāwī al-Ansari ( ar, أبو القاسم خلف بن العباس الزهراوي;‎ 936–1013), popularly known as al-Zahrawi (), Latinised as Albucasis (from Arabic ''Abū al-Qāsim''), was ...
. The gut suture was similar to that of strings for violins, guitars, and tennis racquets and it involved harvesting sheep or cow
intestine The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the digestive system that leads from the mouth to the anus. The GI tract contains all the major organs of the digestive system, in humans ...
s. Catgut sometimes led to infection due to a lack of disinfection and sterilization of the material.
Joseph Lister Joseph Lister, 1st Baron Lister, (5 April 182710 February 1912) was a British surgeon, medical scientist, experimental pathologist and a pioneer of antiseptic surgery and preventative medicine. Joseph Lister revolutionised the craft of s ...
endorsed the routine sterilization of all suture threads. He first attempted sterilization with the 1860s "carbolic catgut," and chromic catgut followed two decades later. Sterile catgut was finally achieved in 1906 with
iodine Iodine is a chemical element with the symbol I and atomic number 53. The heaviest of the stable halogens, it exists as a semi-lustrous, non-metallic solid at standard conditions that melts to form a deep violet liquid at , and boils to a vi ...
treatment. The next great leap came in the twentieth century. The chemical industry drove production of the first synthetic thread in the early 1930s, which exploded into production of numerous absorbable and non-absorbable synthetics. The first synthetic absorbable was based on
polyvinyl alcohol Poly(vinyl alcohol) (PVOH, PVA, or PVAl) is a water-soluble synthetic polymer. It has the idealized formula H2CH(OH)sub>''n''. It is used in papermaking, textile warp sizing, as a thickener and emulsion stabilizer in polyvinyl acetate (PVAc) a ...
in 1931.
Polyester Polyester is a category of polymers that contain the ester functional group in every repeat unit of their main chain. As a specific material, it most commonly refers to a type called polyethylene terephthalate (PET). Polyesters include natural ...
s were developed in the 1950s, and later the process of radiation sterilization was established for catgut and polyester.
Polyglycolic acid Polyglycolide or poly(glycolic acid) (PGA), also spelled as polyglycolic acid, is a biodegradable, thermoplastic polymer and the simplest linear, aliphatic polyester. It can be prepared starting from glycolic acid by means of polycondensation or ...
was discovered in the 1960s and implemented in the 1970s. Today, most sutures are made of synthetic
polymer A polymer (; Greek '' poly-'', "many" + ''-mer'', "part") is a substance or material consisting of very large molecules called macromolecules, composed of many repeating subunits. Due to their broad spectrum of properties, both synthetic a ...
fibers. Silk and, rarely, gut sutures are the only materials still in use from ancient times. In fact, gut sutures have been banned in Europe and Japan owing to concerns regarding
bovine spongiform encephalopathy Bovine spongiform encephalopathy (BSE), commonly known as mad cow disease, is an incurable and invariably fatal neurodegenerative disease of cattle. Symptoms include abnormal behavior, trouble walking, and weight loss. Later in the course of t ...
. Silk suture is still used today, mainly to secure surgical drains.


See also

*
Alexis Carrel Alexis Carrel (; 28 June 1873 – 5 November 1944) was a French surgeon and biologist who was awarded the Nobel Prize in Physiology or Medicine in 1912 for pioneering vascular suturing techniques. He invented the first perfusion pump with Charle ...
*
Barbed suture A barbed suture is a type of knotless surgical suture that has barbs on its surface. While suturing tissue, these barbs penetrate inside the tissue and lock them into place, eliminating the need for knots to tie the suture. Conventional sutures re ...
*
Butterfly closure An adhesive bandage, also called a sticking plaster, medical plaster, or simply plaster in British English, is a small medical dressing used for injuries not serious enough to require a full-size bandage. They are also known by the genericized tra ...
*
Cheesewiring In medicine, the term cheesewiring or cheesewire effect (used interchangeably) describes any process in which cells or intercellular matrix are dissected or extruded either by the material being pressed through a taut element, or by the tension of a ...
*
Chitin Chitin ( C8 H13 O5 N)n ( ) is a long-chain polymer of ''N''-acetylglucosamine, an amide derivative of glucose. Chitin is probably the second most abundant polysaccharide in nature (behind only cellulose); an estimated 1 billion tons of chit ...
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Cyanoacrylate Cyanoacrylates are a family of strong fast-acting adhesives with industrial, medical, and household uses. They are derived from ethyl cyanoacrylate and related esters. The cyanoacrylate group in the monomer rapidly polymerizes in the presence ...
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Knot A knot is an intentional complication in cordage which may be practical or decorative, or both. Practical knots are classified by function, including hitches, bends, loop knots, and splices: a ''hitch'' fastens a rope to another object; a ' ...
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Ligature Ligature may refer to: * Ligature (medicine), a piece of suture used to shut off a blood vessel or other anatomical structure ** Ligature (orthodontic), used in dentistry * Ligature (music), an element of musical notation used especially in the me ...
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List of medical topics The following outline is provided as an overview of and topical guide to medicine: Medicine – science of healing. It encompasses a variety of health care practices evolved to maintain health by the prevention and treatment of illness. ...
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Sewing Sewing is the craft of fastening or attaching objects using stitches made with a sewing needle and thread. Sewing is one of the oldest of the textile arts, arising in the Paleolithic era. Before the invention of spinning yarn or weaving fabr ...
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Surgical staple Surgical staples are specialized staples used in surgery in place of sutures to close skin wounds or connect or remove parts of the bowels or lungs. The use of staples over sutures reduces the local inflammatory response, width of the wound, a ...
* Wound closure strips


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Computer modelling of sutures
{{DEFAULTSORT:Surgical Suture First aid Implants (medicine) Surgical stitches