Understanding suture materials

INTRODUCTION Put most simplistically, operative surgery consists of nothing more than cutting the body's tissues and subsequently sewing them back together again. Therefore to the uninitiated it probably seems that the whole issue of suture materials is simple to understand. There are, however, probably few surgical subjects that generate as much heated debate as the ‘correct’ use of the ‘appropriate’ suture in a particular clinical situation. All surgeons have their own opinions as to the ideal suture material for each situation but sadly this is a decision that is often based on habit, tradition or whim. Surgeons thus empirically find the suture material which best suits them. Therefore different surgeons will often use quite different materials and dimensions of sutures for the same purpose. With increasing knowledge about the physical properties of different suture materials and the tissue reactions to these materials, it becomes increasingly clear that for a given purpose one suture or type of suture is often far more suitable than others are. The purpose of this chapter is therefore to guide the reader through the suture options available, whilst outlining some of the reasons why the diffuse variety of sutures and needles needs to exist. THE HISTORY OF SUTURE MATERIALS The use of thread for wound closure and for ligature is described in the literature as far back as 2000 BC. Since then a great many materials have been used for these purposes, including dried gut, dried tendon, strips of hide, horsehair, women's hair, bark fibres and textile fibres of various kinds. The Greeks were leaders in the field of medicine and the Romans later adopted their techniques. Galen, in the second century AD, used silk and harp cord for ligatures as well as strands of animal intestine to close the wounds of Roman gladiators. In the 10th century Rhazes is credited with being the first to stitch abdominal wounds with harp strings made from spun strands cut from animal intestines. Before the introduction of antisepsis the use of sutures and ligatures presented great problems since their application almost invariably resulted in infection. Pus formation and secondary haemorrhage were therefore common complications. The introduction of antisepsis by Lister in 1867 resulted in a considerable improvement in the infection rate.