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Suturing and knot tying technique
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Basics and history
All surgical specialties inflict superficial and deep wounds, resect organs in parts or in toto and transect structures such as blood vessels. The resulting defects must be closed again with sutures to support biological healing. In the past, sutures were mainly made of natural materials (sheep intestine, bovine collagen, and silk). The introduction of "carbolic catgut" in 1860 established the first " genuine" suture material in surgery.
Illustrations from Egypt dating from around 3000 BC already depict surgical instruments such as eyed needles. The oldest surviving suture, placed around 1100 BC, was found in the abdomen of a mummy.
Since the discovery of bovine spongiform encephalitis (BSE), suture materials made from animal products may no longer be used.
Today, modern products are classified as absorbable (e.g., made of polydioxanone or polyglactin) and non-absorbable sutures (e.g., made of polyamide or polypropylene). Depending on the absorption rate of the material, absorbable sutures are characterized by different half-lives; thus, the remaining tensile strength of the suture material will vary according to its half-life. The absorption of the material is not the same as its tensile strength, but with increasing half-life, the tensile strength also increases.
Suture materials are classified according to their structure: Monofilament, braided/plied, multifilament, and pseudomonofilament sutures, which will be discussed in more detail in the section on the different areas of application.