sutura

Suture comes from Latin sutura, meaning a seam, a sewing together, from suere (to sew), from the Proto-Indo-European root *syū-, meaning to bind or sew. This is the same root that produced the Sanskrit sūtra (a thread, a rule — literally 'that which is sewn'), the English word 'sew,' and the German nähen (to sew). The anatomical suture — the immovable joint between the bones of the skull — received this name because the interlocking bony edges resemble the serrated seam of a leather shoe. The surgical suture — the thread or wire that closes a wound — received the same name because it is, quite literally, a sewing. In Latin medical writing, sutura named both seamlessly: the seam that nature makes between bones and the seam that the physician makes between tissues.

Wound closure is among the oldest of surgical procedures, predating any concept of medicine as a profession. Archaeological evidence from prehistoric sites shows trepanned skulls — skulls with holes bored into them — that exhibit evidence of healing, meaning patients survived the operation. Egyptian papyri from around 1600 BCE describe wound closure using strips of linen, adhesive plasters, and stitches. The Edwin Smith Papyrus, the oldest known surgical document, records treatment of wounds including directives for closure. Sanskrit texts from ancient India describe suture techniques in considerable detail, specifying different stitching methods for different wound types and recommending natural fibers, horse hair, and thin strips of bark as suture materials.

Ambroise Paré, the prolific French Renaissance surgeon whose work also transformed prosthetics and antiseptic practice, systematized suture technique in the sixteenth century. He described the ligature — the tying of blood vessels to control bleeding — and the use of sutures to close surgical wounds after amputation and other procedures. Before Paré, surgeons routinely cauterized amputation stumps with boiling oil to stop bleeding; his introduction of ligature was a transformation in post-operative survival. The suture thread of the sixteenth century was silk or catgut (actually made from sheep intestines, not cat gut, the name being a corruption of 'kit-gut' or small violin string gut), both materials that would be used for centuries.

Modern sutures divide into two categories based on a property that Paré's silk threads did not have: absorbable and non-absorbable. Absorbable sutures, made from materials that the body's enzymes gradually dissolve — catgut, polyglycolic acid, polyglactin — are used for internal tissues that must be closed but cannot later receive the attention of a physician removing stitches. Non-absorbable sutures, made from silk, nylon, polypropylene, or stainless steel, are used for surface closures or permanent structural repairs. Surgical staplers have largely replaced sutures for closing the skin in many abdominal operations. Tissue adhesives — essentially surgical superglue — close lacerations in emergency rooms with no needle required. The sewing metaphor that gave the suture its name is becoming increasingly literal as robotic surgical systems thread needles with a precision no human hand can match.