History of Surgical Threads
Surgical thread have been used since ancient times to closure off wounds that can heal themselves, even with different materials. It is possible to encounter quite interesting tables if we look at the history of the surgical threads. Between 50,000 and 30,000 BC, it is thought that the first eyelid surgical needles have been discovered. The bone needles discovered in the 20,000 BC are evident in the examination of the Neolithic skulls, which are widely used up to the Renaissance. The bones that grew into the needle hole indicate that the patient survived the operation as well as continuing his life in a healthy way after the operation. These findings explain that even primitive people perform surgical procedures. The North American Indians used cautery, African ties tied up their blood vessels with tendons, used acacia awns to close wounds, stitching with the help of a local plant cover on the stitch line and finally throwing eight knots shows that the use of surgical threads has been a major necessity since ancient times. When we came to the 1900s BC, there were some surgical application techniques and operative rules engraved on the temple column during the Babylonian king Hamurabi years. These rules prove that the surgeries were carried out at that time. Remaining inscriptions from the year 2000 BC clearly show that use of wires and nerves to connect and stitch. Robert Felkin, the missionary; Describes the cesarean operation performed successfully in 1879 in Uganda using the cautery and pricking method. A South American method is to bring the wound lips closer using the strong jaws of the big black ants. In this method, it is known that the ant body is twisted and torn to leave the head on the wound. It is known that horse tails were used as surgical threads in ancient Greeks. A surgical papyrus found in Thebes shows the most commonly used material was linen surgical thread to bring the wound edges closer together in Egypt. It is also known that collagen and organic fiber roots, dry intestines, dry tendons, horsehair, animal skin strips,woman hair and tree fibers used as surgical threads. The first anatomist Greek physician, Galen, first mentioned of silk and “catgut” in his book ‘De Methoda Medendi’ 1800 years ago. It is thought that this book is the first source for the catgut, although it is known that has been used before. The catgut seems to have become very popular in the 1840s with the suggestion of Arab physician Razi to using catgut to practitioner surgeons in the 9th century. Surgical thread used until 1930’s were generally catgut, silk, linen and cotton while Polyamide (Nylon) was used in 1941 as synthetic surgical threads. It started during the World War. Then polyester, polyacrylonitrile, polyolefin materials were used as surgical threads. None of these materials have been produced for surgical use and have begun to be used in textiles with the developments in the textile industry; Then this use has begun to be tried in surgical operations. In 1970, the first absorbable, synthetic surgical thread PGA (a homopolymer of glycolic acid (polyglycolic acid)) was launched to the market for surgical use. The fact that despite the slower duration of absorption compared to the catgut, PGA has low tissue reaction and strong knot strength, these created a wide use area for PGA as surgical thread. Subsequently, with the developing technology, materials such as absorbable PDO (polydioxanone), PGCL (polyglyapron), PGLA (polygluconic co-lactic acid) and non-absorbable PP (polypropylene) was produced.
Synthetic surgical thread chronology is as follows;
- 1941 Polyamide
- 1958 Polyester
- 1969 Polypropylene
- 1970 PGA
- 1974 PGLA
- 1985 Polyglyconate
- 1989 Polydioxanone
- 1993 PGCL
- 1995 PGLA Rapid
- 2003 Antibacterial PGLA (Triclosan)
- 2006 Antibacterial PGCL, PDO (Triclosan)
- 2010 Antibacterial PGLA, PGCL, PDO, PGA (Chlorhexidine)
Surgical threads, which have been in our lives since primitive ages and which are so important for human health, are now used in every surgical operation without exception. For this reason, this area is still being improved and new materials are being tested by keeping patient health in the forefront. Today, the inability to close wound with any material as in ancient times, has increased the interest in safe synthetic materials with proven biocompatibility with relevant tests.