HX18 Sewing through time: the fascinating history of surgical suture innovation

Abstract The evolution of suture materials has significantly impacted dermatological surgery, progressing through key milestones that reflect the interplay between material innovation and the evolving needs of wound closure, infection control and cosmetic outcomes. Ancient civilizations in India and Africa utilized locally sourced materials such as plant fibres, hair and animal tendons. The Edwin Smith papyrus (1600 Bce) described the use of linen threads in wound closure, while Sushruta (500 Bce) introduced catgut sutures and innovative techniques, such as using black ants bites and jaws as natural ‘staples’ for wound closure. These early practices laid the groundwork for absorbable sutures in modern surgery. The Classical and Mediaeval periods saw advancements, with silk and gut sutures used by Roman physicians like Galen. The Islamic Golden Age introduced refinements such as Avicenna’s use of pig bristles for monofilament sutures, demonstrating greater durability in infected wounds. The Renaissance and early modern periods marked a resurgence in suture use, exemplified by Ambroise Paré’s utilization of silk and linen for battlefield surgeries. Advances in trade routes during this time also made silk sutures more widely available, facilitating their use in increasingly complex surgeries. The 19th century was transformative, particularly with Joseph Lister’s introduction of antiseptic techniques and sterilized catgut sutures, significantly reducing postsurgical infections. Chromic-treated catgut, which delayed absorption, further improved wound support by allowing more predictable healing, a key factor in achieving better cosmetic results in dermatological surgery. The 20th century saw the development of synthetic sutures, such as polyglycolic acid and polyglactin, offering improved handling, tensile strength and biocompatibility. These materials revolutionized dermatological surgery by enabling precise closures and enhanced cosmetic outcomes. While early sutures were inherently sustainable due to their reliance on locally sourced, biodegradable materials, modern innovations have prioritized patient outcomes, often at the expense of sustainability. The trade-off for better infection control, tensile strength and handling properties has been the reliance on synthetic, petrochemical-derived materials. However, revisiting principles from ancient practices may inspire future sustainable advancements in suture technology. By analysing key historical milestones, we highlight not only the advancements in suture technology but also their functional impact on dermatological surgery, including improved wound healing, infection control and cosmetic outcomes.