The History of Suture Material

The technique of closing wounds by means of needle and thread is several thousand years old. The history of surgical sutures can be traced back to ancient Egypt, and the literature of the classical period contains a number of descriptions of surgical techniques involving sutures.
Before catgut became the standard surgical suture material towards the end of the 19th century, many different paths had been followed to find a suitable material for sutures and ligatures. Materials that had been tried included gold, silver and steel wire, silk, linen, hemp, flax, tree bark, animal and human hair, bowstrings, and gut strings from sheep and goats.

At the beginning of the 19th century metal threads were tested as suture material. At that time inertness of a material with respect to body tissues was considered an advantage. Nevertheless, metal threads had major disadvantages: their stiffness rendered knotting more difficult and could easily result in knot breakage; in addition, suppuration of the wound edges occurred frequently.

These negative experiences with metal contributed to the establishment of silk as the number one suture material. Wounds sewn with silk cicatrised within a few days, and the small knot caused no problems. For these reasons most surgeons at that time chose silk for sutures and vessel ligatures. A fundamental change in the assessment of suture materials followed the publication in 1867 of Lister’’s research on the prevention of wound suppuration. On the basis of work by Koch and Pasteur, Lister concluded that wound suppuration could be prevented by disinfecting sutures, dressings, and instruments with carbolic acid. Initially Lister used silk as a suture material, on the assumption that it was absorbable and therefore could also be used for ligatures. Later he searched for a more rapidly absorbable material and consequently began to use catgut.
Catgut is produced from animal connective tissue, in particular bovine subserosa. Over the years it gradually emerged that animals born and bred in South America were most suitable because they had the lowest fat content thanks to their natural husbandry conditions.

The use of catgut was never called into question until the appearance of BSE at the beginning of the 21st century. Alternative products had already been developed by this time. These are the synthetically manufactured absorbable suture materials which have largely superseded catgut in Europe. However, catgut continues to play a major role in woundcare world-wide.

A wide variety of sterilization methods have been tested at various times. Nowadays sutures are mostly sterilized by ethylene oxide or gamma irradiation.

In response to the requirements of modern surgery and thanks to the efforts of users and manufacturers over the last few decades, a wide variety of sutures have now been developed by SMI in Belgium and Duggan Veterinary have made these sutures available to all Irish Veterinary Surgeons.