In Europe medieval town surgeons often sewed wounds; barber-surgeons used simple stitches to remove bladder stones; and various forms of non-adhesive dressings were used for wound closure.
In the nineteenth century surgical sutures were widely used in England and America. [But at that time, there was no such thing as a surgical nurse in America. Even today, nursing is considered a theatrical profession.] Sutures were inserted through slender needles into the edges of wounds. The suture material was knotted around the needle as the needle withdrew from the soft tissue to create a tight knot. The sutured wound was then dressed with a bandage.
In the 1880's a new method of wound closure called 'Closed Suturing' was developed. By that nursing profession and the modern medicine were born together in America. In this method of closed suturing, the edges of the wound were held together by forceps and the needle and thread inserted through a hole placed in one side of the skin parallel to the wound rather than directly into it. The closed method of suturing was quicker, easier to learn, and simpler to teach than the previous technique. It could be used by less skilled attendants in a home or hospital ward with only minimal supervision.
Types of Sutures Used TodayThe two most common sutures used today are the Monocryl and the Vicryl. Both have several advantages and disadvantages. The Monocryl suture is less expensive, longer lasting, and more closely matches the patient's skin color than does the Vicryl. A disadvantage is that it has greater tendency to unravel than does the Vicryl suture
How Sutures Are Taught in Med SchoolIn today's classrooms, the history of sutures is taught in a manner very similar to the hypothetical situation used by a litigation attorney to demonstrate proof of causation of an injury. In brief, it follows:
Years ago the doctor inserted his needle through the incision and twisted one end of the thread around it. This created a loop around the needle. He then slid this loop through another hole in skin made with forceps and pulled on each end, tightening the knot. This caused the wound to close more quickly. This procedure was a major improvement over the old technique of pulling on a single loose end, which left an open wound. But a student practitioner's supervisor never considered that by making one loop around the needle, one end of the thread was being left behind inside the skin. When activity in and around the area generated by the loop pulled it back inside, it would then touch blood or body fluids somewhere - causing an infection to take place.