Stitch in time: 18 fascinating facts about the history of sutures

The first eyed needles appear to have been used both for surgery and to tie wounds together during this time, according to the fossilized remains of Neolithic skulls.

Greek surgeon Galen of Pergamon notes that he uses silk or catgut (made from the twisted intestines of sheep or horses) to suture together gladiators’ severed tendons. Similar materials are used for sutures well into the 20th century.

Egyptian records reveal the first historical reference to sutures being used to treat a shoulder: “Thou shouldst draw together for him his gash with stitching.”

British surgeon Sir Joseph Lister—who helped introduce the concept of antiseptic surgery—gives a presentation at the Philadelphia Centennial Exhibition’s Medical Congress that inspires medicated plaster maker Robert Wood Johnson to start Johnson & Johnson, aimed at furthering the cause of sterile surgery. “In those times, surgeons used to operate in their street clothes, and would carry the same instruments and dressings from patient to patient, not even cleaning them in between use,” says Margaret Gurowitz, Chief Historian at Johnson & Johnson.

Johnson & Johnson starts manufacturing sterile sutures (made of either catgut or silk), surgical dressings, cotton and gauze. “This helped usher in the beginnings of modern antiseptic surgery,” Gurowitz says, “and, as a result, patient survival rates in American hospitals skyrocketed.”

Scottish pharmacist George Merson, who runs a suture manufacturing company, develops eyeless needled sutures with a single strand of material pre-attached through the butt of the needle. This invention greatly reduces tissue damage caused by pulling double strands through the skin.

Johnson & Johnson acquires Merson’s company and absorbs it into the company’s existing suture business, renaming the new conglomerate Ethicon Suture Laboratories. In 1953, the name is changed to Ethicon Inc.

The company creates technology that allows sutures to be sterilized by bombarding them with radiation. This is heralded as a breakthrough because it allows sutures to be sterilized once already sealed in their final packaging, ensuring bacteria stays out.

Ethicon unveils a synthetic sterile suture made from the polymer polypropylene—and, to date, it remains the gold standard for cardiac bypass surgery. “It’s still a favorite for cardiovascular surgeons because it stretches easily and doesn’t tear,” says Liza Ovington, Ph.D., Franchise Medical Director for Ethicon.

Ethicon introduces Vicryl, a synthetic suture that can be naturally absorbed into the skin. It’s also braided, making it stronger and more pliable.

A simple addition to Vicryl makes the suture even safer to use: “The coating helped surgeons’ knots slide down more easily and stay put when they were tying the sutures, and reduced trauma to surrounding tissue,” Ovington says.

Ethicon creates sutures made of polydioxanone that are designed to close fascia, the connective tissue beneath the skin. “When performing an operation, surgeons think about tissue in layers: first, there’s the skin, then the fascia, and then the actual organ,” Ovington explains. “Since fascia heals more slowly, we wanted to create a product that would keep its strength for about six weeks, compared to the three to four weeks offered by Vicryl, to provide longer-lasting support.”

The suture, designed specifically for skin, provides even more secure skin closure and prevents wound edges from separating, which can lead to infection and scarring. Thanks to Monocryl’s high initial strength, it keeps wounds pulled together tightly during the critical first few days of skin healing.

The first FDA-cleared topical skin adhesive in the U.S., Dermabond® Topical Skin Adhesive®, paves the way for a new generation of skin-closure solutions. “It provides a mechanical barrier to infection when applied to the incision,” Ovington explains. In vitro data shows that, when used in tandem with deep dermal sutures, Dermabond Adhesive adds more strength in closing wounds, provides a microbial barrier for at least 72 hours against bacteria responsible for surgical site infections, and can even inhibit such antibiotic-resistant bacteria as MRSA.

This suture—the first antibacterial version made commercially available with triclosan, which prevents bacteria from congregating on the suture—is shown to significantly reduce the risk of developing a surgical site infection by almost a third.

The needles, made with one of the world’s strongest metal alloys, mark a significant departure from the stainless-steel needles of the past, providing more sharpness, strength and bend-resistance. “Patients with heart disease today often have more calcium deposits in their arteries, and thus require tougher needles to get through all the calcified tissue,” Ovington says, adding that they’re also smaller and thinner, helping minimize tissue trauma and bleeding.

The suture, designed with anchors along the length of the string, transforms surgery. Prior to its invention, surgeons sutured together tissues by creating individual loops, then knotting them off—a cumbersome and time-consuming process that can lead to complications. Since Stratafix has multiple points of fixation, it removes the need for knots and enables for more efficiency and strength than traditional suturing. “It’s like a zipper bringing tissue together and holding it everywhere, compared to just a couple of buttons,” Ovington explains.

This technology is even stronger than surgical sutures or staples, provides a protected closure and is associated with high patient satisfaction.