The History of Suture - Essay Example

The History of Suture Introduction “The history of wound suturing reflects that of surgery itself” (Kuijjer, 1998, p.473). Wound treatment includes the technique of suturing as well as suturing materials used for the purpose. In ancient India, Egypt, Greece and Rome, wound treatment and suturing techniques and instruments were developed which have a close resemblance to those in contemporary use. Suturing materials such as catgut and silk have been used since ancient times. Until the 19th century, the materials and techniques of suturing did not evolve greatly. In 1860, Lister began the improvement of catgut. Also in the 19th century, prototypes of mechanical suturing instruments known as staplers were developed, and were introduced into clinical practice in the early decades of the 20th century. After World War II (1939-1945), the greatest developments in wound suturing began with the introduction of advanced, partly automatic stapler machinery, as well as the manufacture of synthetic non-resorbable and resorbable fibres. These revolutionary techniques fuelled the development of new fields such as microsurgery (Kuijjer, 1998). Thesis Statement: The purpose of this paper is to investigate the history of suture including advances in suturing techniques and the evolution of suturing materials. The History of Suture The history of surgery is inextricably linked with the history of suturing, or stitching together two surfaces or edges. Allusion to sutures and the suturing of wounds in an ancient Egyptian scroll (circa 3,500 BC) is considered as the oldest existing surgical treatise. The term suture means to sew, which Hippocrates used in 400 BC. About 1000 years before Christ, the Indian medical book Charaka’s Samhita described many techniques of suturing including the closing of wounds by ant pincers in bowel surgery. Once the large black ants with powerful jaws clamped the edges of the wound together with their pincers, their bodies were twisted off (Snyder, 1976). In 600 BC the ancient Indian surgeon Sushruta’s medical treatise is a compilation of plastic surgery and opthalmology which mentions sutures made from animal sinews, braided horsehair, leather strips, cotton and fibers made from the bark of the ashniantaka tree. From 100 BC Egyptian mummies have shown evidence of sutured wounds. Further, in 100 BC, a learned Roman, Cornelius Celsus used the word suture both as a noun and as a verb: to suture; “he also named the skull sutures coronal, sagittal, and lambdoidal” (Snyder, 1976, p.401). By 30 AD, the Roman Celsus again described the use of sutures and clips, and in 150 AD, Galen used silk and catgut, and explained their use as sutures (Galli, 2011). Soon sutures were used to tie off tissues, through a process called ligature. In 165 AD, Galen who was physician to the Roman gladiators recommended their use for their wounds, to prevent paralysis. In 1555, Ambroise Pare, the French military surgeon changed his treatment of bleeding vessels caused by amputation, from hot irons and boiling oils to ligation. He also introduced the use of stitched linen adhesives to close saber wounds and to prevent scar formation. Also among the early advocates of suturing all fresh wounds as well as severed tendons and tissue was Andreas Vesalius, the greatest anatomist of the Renaissance (Snyder, 1976). The history of sutures which began more than 2000 years ago correlates with the first records of eyed needles. Before the end of the first millennium, Avicenna used monofilament with pig bristles in infected wounds. Surgical and suture techniques advanced significantly in the late 1800s, with the development of sterilization procedures. Subsequently, modern methods created uniformly sized sutures (Galli, 2011). The Evolution of Suturing Materials According to Mackenzie (1973), the term sutures includes those which hold a wound together until it has healed, as well as ligatures used to tie off a blood vessel such as an artery. Between 50,000 and 30,000 BC, eyed needles were invented and used for suturing. From 20,000 BC till the Renaissance (1400s to the beginning of the 1600s), bone needles were of an unsurpassed standard. These needles’ use as sutures is evident from Neolithic skulls showing that during this period trepanning was successfully carried out. The inward growth of bone from the edge of the hole reveals that the patient survived for a considerable period of time after the surgery (Fasnacht, 2008). The suture needles used today are evolved forms of ancient needles, and are not a revolutionary new development. They are contemporary and improved versions of the older needles (Scribd, 2011). Conventionally, suture materials comprise of catgut which accounts for nearly half of all sutures and ligatures, with the remainder being non-absorbables such as “silk, linen, steel wire and sythetics such as polyester, nylon and thenewly developed polypropylene” (Mackenzie, 1973, p.168). In the 1950s the first synthetic sutures were developed, which have developed into advanced forms. The various types of sutures differ in their quality thereby impacting their handling, knot security, and strength for different purposes. Thus, it is difficult to devlop a single suture that offers all the required characteristics, with the trade-off frequently being in “tissue handling versus longevity versus healing properties” (Galli, 2011). The natural materials catgut and silk used traditionally as sutures continue to be used today. With the introduction of a reconstituted absorbable collagen suture, the first absorbable synthetic suture was developed in the early 1970s. These new synthetics both absorbable and non-absorbable form the fore-runners of new generations of sutures which in combination with other means of tissue coating such as physiological glue, forecast exciting possibilities for this industry (Mackenzie, 1973). Modern day gut sutures are made of specially prepared beef and sheep intestine. Untreated suture is known as plain gut, while chromium gut is treated with chromium salts to increase its resistance to absorption. Fast gut are heat treated gut sutures, they are absorbed more rapidly. Most absorbable sutures today are composed of synthetic polymer fibres, which may be either braided or monofilament (Scribd, 2011). “Each major suture manufacturer such as Ethicon or Covidien” (Scribd, 2011) manufacture their own proprietary formulations for their brands of synthetic absorbable sutures, made of various blends of polyglycolic acid, polylactic acid or caprolactone. They are preferred because of their lack of toxicity, ease of handle, low cost, low tissue reaction, and consistent performance. In collaboration with surgeons over several years to meet patients’ needs, products such as Covidien suture, Autosuture, Covidien mesh, Ethicon mesh, Ethicon stapler, and others have been developed. Other forms of suturing materials being increasingly used today are adhesive tapes, strips and staples. Conclusion This paper has highlighted the history of suture, and examined its evolution from over 50,000 years before Christ. The evidence indicates that natural suturing materials such as catgut and silk were used since ancient times, as were eyed bone needles for suturing. The materials and techniques developed slowly over the millennia, with the most rapid advancement occurring in the 19th century. The first synthetic sutures were used from the 1950s, and these have evolved over the years into absorbable and non-absorbable varieties. which have developed further into new generations of sutures. From the 1970s reconstituted absorbable collagen suture were introduced. These products have been combined with other means of tissue coating such as physiological glue, for increased improvement in the quality and efficiency of suture materials. Modern suture manufacturers such as Ethicon and Covidien create their own brands of syntheic absorbable sutures. These new sutures are found to be the most effective in all aspects related to performance and ease of use. Adhesive tapes, strips and staples are also various forms of sutures in use today for different types of surgeries. It is concluded that the history of suture is a fascinating one, because suturing has been a vital component of surgery since ancient times until today. ------------------------------------ References Fasnacht. (2008). The history of suturing. Retrieved on 14th May, 2011 from: http://www.solidrockvirtualschool.com/vidio/0%20%20HISTORY%20OF%20SUTURING%20I.pdf Galli, S.K.D. (2011). Wound closure technique. Medscape. Retrieved on 14th May, 2011 from: http://emedicine.medscape.com/article/1836438-overview#a01 Kuijjer, P.J. (1998). History of healing: Wound suturing. Ned Tijdschr Geneeskd, 142(9): pp.473-479. Mackenzie, D. (1973). The history of sutures. Medical History, 17(2): pp.158-168. Scribd. (2011). History of suture needles and sutures. Retrieved on 14th May, 2011 from: http://www.scribd.com/doc/20319366/History-of-Suture-Needles-Sutures Snyder, C.C. (1976). On the history of the suture. Plastic and Reconstructive Surgery, 58(4): pp.401-406. Read More