Suture Materials, 1980s: Properties, Uses, and Abuses

Throughout antiquity many materials have been used to approximate wounds. As early as 5000-3000 B.C.E., eyed needles were used to pass suture material through surgical wounds. By 2000 B.C.E. boned needles began usage in a fashion unsurpassed until Renaissance times. Materials connected to these needles included flax, hemp, fascia, hair, linen strips, pig's bristles, reeds, grasses, and other exotic materials available. Tying of locks of scalp hair into knots to close scalp wounds was common djring battles and is still employed as a temporary measure in some busy emergency rooms. Perhaps the most legendary wound closure was the use of the mouth parts of the pincher ant. In all, natural products alone sufficed as suture material until the 1940s. These included silk, cotton, linen-cotton, and catgut. During this decade, nylon and dacron became the first synthetic materials made into suture. Later, polyethylene, polypropylene, polyglycolic acid, and polyglycan 910 were developed and added to the surgeon's armamentarium. For years, the surgeon had no choice but to use silk and catgut to close wounds. With the advent of modern suture material, one should become familiar with the different characteristics of each so that he may best use the most appropriate product. The qualities of the ideal suture material have been bantered for years. Characteristics of such a suture material include superior tensile strength, good knot security, excellent handling characteristics, minimal, nonallergenic tissue reaction, resistance to infection, and eventual absorption (of absorbable suture products) when tissue repair has reached satisfactory levels. Unfortunately, there is no ideal suture material. The U.S. Pharmacopeia divides sutures into two groups, the ahsorhable and the nonabsorhahle. In general, absorbable sutures lose tensile strength in less than 60 days; nonabsorbable sutures maintain tensile strength