Читать книгу The Little Book of Medical Breakthroughs - Dr. Naomi Craft - Страница 6

A surgical suture is used to stitch together the edges of a wound after an operation or to repair damaged tissue.

Some sutures dissolve, others don’t. They can be man made or natural (from silk, linen and catgut). Some are made out of one single filament, which causes less damage to the tissues but are harder to knot, or several filaments that are braided or twisted together.

Some of man’s earliest records show evidence of sutures. We know needles were used at least 3,000 years ago and archaeological records from ancient Egypt show that the Egyptians used linen and animal sinew to close wounds. In ancient India, physicians used the heads of beetles or ants to staple wounds shut. The live creatures clamped the edges of the wound shut with their pincers. Then their bodies were twisted off, leaving their heads in place. Other natural materials used by doctors in ancient times included flax, hair, grass, cotton, silk, pig bristles and animal gut.

The first description of catgut was in 175 AD. Made from sheep intestine (and bearing no relation to cats) this was easily available from musicians who used it for strings.

Not much progress was made in the use of sutures until the 19th century, when surgery became a viable option with the invention of adequate anaesthesia. Although surgery was less painful, wound infections were a major cause of death. Sutured wounds seemed more likely to become infected, so many surgeons preferred not to use them.

In 1847, the Viennese obstetrician Ignaz Semmelweis (1818–1865) discovered that handwashing considerably reduced the risk of infection, making surgery much safer. Having realized the benefit of disinfectant, Joseph Lister (1827–1912) Professor of Surgery in Glasgow, Scotland, used carbolic acid to clean his hands and instruments, and also soaked his catgut sutures in it. The infection rate fell dramatically and carbolic-soaked catgut became widely accepted by 1860.

As well as his contribution to antisepsis, Lister was the first to discover that the body absorbed catgut sutures. Absorbable sutures are useful for a wound that doesn’t need to be supported for more than a few days. Lister realized that if he soaked his sutures in chromic acid, like the tanners who used it to soak their leather, the catgut would last a week or longer. In 1881 chromic catgut was introduced.

By 1890 the catgut industry was firmly established in Germany, thanks to its use in the manufacture of sausages. From 1906 it was also sterilized using iodine.

Catgut was the staple absorbable suture material through the 1930s and, at one stage, one of the major manufacturers of catgut sutures, Ethicon, reported using intestines of 26,000 sheep a day! Where a nonabsorbable material was needed, surgeons continued to use silk and cotton. Suture technology advanced with the creation of nylon and polyester in the late 1930s. Needle technology also advanced and surgeons began using a needle which was crimped onto the suture, therefore reducing the trauma to the wound because the needle and the suture were the same width.

In the 1960s chemists developed new synthetic materials that could be absorbed by the body, such as polyglycolic acid and polylactic acid, and better sterilization technology, so that sutures could be sealed in a package and then sterilized, as they are today.

See: General Anaesthetic, pages 48–49; Handwashing, page 72; Sanitation, pages 61–62