Stitches or Sutures: Wound Closure Today and in History

An atraumatic (swaged) needle and attached thread held in a needle holder; in this case, the suturing needle is curved
An atraumatic (swaged) needle and attached thread held in a needle holder; in this case, the suturing needle is curved | Source

Closing Wounds

From ancient to modern times, healers have joined the separated edges of wounds together by sewing. It’s a good technique to close spaces, reduce infection, speed healing and minimize scarring. Stitches are still the most common method of repairing large and gaping wounds today, but newer techniques are being used as well. These methods include sealing injured areas with medical tape, adhesive and staples. The use of lasers to close wounds may be common in the near future.

As long ago as the Upper Paleolithic period, people sewed. They punched holes in animal hides with needles made from bone, antler, horn or ivory and then drew thread through the holes. It’s unknown when people first realized that just as pieces of animal skin can be sewn together, so can pieces of human skin.

Ancient Greeks, Romans and Egyptians - and perhaps even earlier cultures - knew about the value of suturing (stitching) wounds. The earliest written records describing the use of medical sutures come from Ancient Egypt, where physicians used stitches to close injuries, incisions and mummies, but the medical uses of stitches may have begun long before this time.

A flat bone sewing needle from the Upper Paleolithic period
A flat bone sewing needle from the Upper Paleolithic period | Source

Early Needles and Threads

The oldest known eyed sewing needle is about 25,000 years old and was discovered in France. It’s made of bone. Even older implements that may have been sewing needles have been found. The earliest threads were probably plant fibers like cotton, flax and hemp, or animal fibers such as hair, muscle strips, tendons, nerves, arteries, strips of gut and silk.

The eyed needle is a dual-purpose device and was a very useful invention in human history. Using one end of a needle to pierce holes in two pieces of material and the other end, or eye, to pull a thread through the holes to join the materials together is a simple but effective technique. It's helpful for both repairing damage and making new items.

As time progressed, metal needles replaced bone ones. The earliest known iron sewing needles were discovered in Germany and date from the third century B.C. Today both metal needles and needles made of synthetic materials are available.

Although eyed needles are used in medicine today, a newer type in which the thread is fused with the needle is often preferred.

Ant bites have been used to provide natural sutures.
Ant bites have been used to provide natural sutures. | Source

Suturing Solutions in Nature

Nature has provided people with suturing materials in the past and sometimes still does in the present. Large ants are used as suturing agents in some cultures. An ant is provoked so that it bites the edges of a wound, pulling them together. The insect’s body is then removed, leaving the head grasping the broken ends of the skin and acting as a clamp that sutures the injury. Another natural technique is to use plant thorns as needles and plant fibers as threads.

Needles and suture materials from nature may be useful in an emergency, but they are more likely to produce infected wounds than modern suturing techniques performed by medical professionals. Doctors know how to clean wounds properly and stop bleeding if it's still occurring when a wound is about to be stitched. They use sterilized needles and thread and are experienced in minimizing scar formation or scar visibility.

Using an Ant to Seal a Wound

Modern Suturing Needles

Modern suturing needles come in a range of body and tip shapes, enabling a doctor to choose the best implement for the job at hand. A variety of threads and stitch styles can be used to create the sutures.

Suturing may be performed with an eyed needle and separate thread that needs to be drawn through the eye before use. It may also be done with an eyeless needle called a swaged or atraumatic needle, which is supplied by the manufacturer with the thread pre-attached. Swaged needles are "atraumatic" because they generally have a gentler effect on body tissue. The suturing needle is held in a needle holder, which the sewer moves to guide the needle and its thread as he or she sutures a wound.

Interrupted Sutures on a Banana (for Veterinary Students)

In interrupted sutures, the stitches aren't connected. Each stitch is individually placed and tied. In continuous sutures, one piece of thread is used to create all of the stitches. The thread isn't cut and tied until the last stitch has been created.

Suture Materials

A wide range of materials are available to make the threads of today’s sutures, giving a doctor many options. Sutures are classified as absorbable or non-absorbable. Absorbable sutures, also known as dissolving stitches, are eventually broken down by the body, while non-absorbable sutures need to be removed once a wound has healed and the broken skin pieces have formed a permanent bond.

Absorbable sutures are often made of synthetic polymers produced from substances such as polyglycolic acid. In some countries absorbable sutures are also made of gut material obtained from cow or sheep intestine. This material is sometimes called "catgut", but it isn't made from cat organs. Two varieties of catgut are plain catgut and chromic catgut. Chromic catgut has had chromium salts added so that it lasts longer in the body. Non-absorbable sutures are made from silk, nylon, polypropylene, polyester or other artificial materials.

Continuous Sutures (for Veterinary Students)

Although interrupted sutures take longer to create than continuous ones, they are more popular. If one interrupted stitch breaks, the others may be able to keep the wound closed. This is less likely in continuous sutures.

Closing Wounds with Butterfly Stitches, Adhesives and Staples

Butterfly Stitches

Butterfly stitches are narrow strips of adhesive tape which are used instead of true stitches to seal small wounds. They are placed across a wound to pull the broken edges of the skin together.


Skin adhesive is sometimes called skin glue or liquid stitches. It's generally used to treat minor wounds with straight skin edges. As the liquid adhesive dries it pulls the edges of the wound together. The adhesive is waterproof (but it does need to be gently patted dry after a bath or shower) and eventually falls off.


Surgical staples are also used to hold the edges of broken skin together. In addition, they’re sometimes used to hold broken parts of a lung, intestine or other organ together because staples may allow less air or body fluids to escape than thread sutures do (although thread sutures that are correctly placed are often considered to be just as effective as staples).

Staples are quicker to apply than regular sutures and can be placed accurately and evenly. The staples are made of a titanium alloy, stainless steel or a plastic. There are even absorbable staples made from polyglycolic acid.

Healing Wounds with Lasers

Laser Tissue Welding

Sealing wounds with a laser is an exciting new treatment that offers several advantages over other wound closure methods. Laser treatment repairs damage rapidly and produces a watertight seal. It shortens the time needed for surgery as well as the wound healing time. The technical name for the process is photochemical tissue bonding or laser-assisted nanosuturing.

Laser sutures have been tested on animal tissue and in humans. Researchers at the Massachusetts General Hospital report that when the skin on each side of an open wound is coated with a dye called Rose Bengal, green laser light will seal the wound. The light activates the dye and and causes it to bind the collagen in the separated pieces of skin together. Unlike the case with the first laser suture experiments, the skin isn't heated or burned.

The bond between the skin sections is continuous and lacks the gaps that occur between conventional sutures. This may decrease the chance of an infection developing. In addition, the researchers found that the healed wound had an improved appearance and that the patients who received the laser treatment experienced less inflammation than with the usual treatments.

Rose Bengal is a stain that is sometimes used by ophthalmologists to make parts of the eye stand out. It's being investigated for other medical uses besides eye examinations and laser welding.

Guiding Light into Deep Tissues

A potential problem with creating laser sutures is that the light doesn't penetrate deeply into tissues. This has limited the use of lasers in closing wounds. Recently, however, a group of researchers reported that they had created a bioabsorbable, comb-shaped waveguide that sends light into deep wounds. A bioabsorbable device gradually breaks down in the body, so it doesn't need to be removed once it's done its job.

The scientists found that when their device was used, light was able to travel ten times deeper into pig skin than it could in regular photochemical tissue bonding. Furthermore, the light was able to seal the wound throughout the thickness of the tissue.

The small intestine and the colon and rectum (large intestine); sutures in the intestine must be strong to prevent the intestine from bursting
The small intestine and the colon and rectum (large intestine); sutures in the intestine must be strong to prevent the intestine from bursting | Source

Lasers and a Protein Glue For Closing Wounds

Researchers at Arizona State University have created a "glue" that improves the effect of laser treatment on wounds. This improvement may be important in sensitive areas of the body, such as the intestine. Waves of muscle movement travel through the wall of the intestine to push food along its journey. The movement of muscle and food puts pressure on the intestinal wall.

There has been some concern that although lasers seal wounds rapidly, the seal might sometimes be weak, which could be serious in the intestine. Holes in the intestinal wall would allow food, enzymes and bacteria to enter the abdominal cavity. This could cause a potentially life-threatening infection and dangerous inflammation.

The Arizona researchers have created a protein-based glue that also contains gold nanoparticles. These particles are rod-shaped and are 50 nanometers long and 15 nanometers wide. (A nanometer is one billionth of a meter,) The gold rods absorb near-infrared light from a laser beam and heat up, causing the artificial proteins in the glue to coagulate. The glue therefore acts a solder when it's placed over a wound and heated by a laser.

In experiments with pig intestines, the researchers have found that their new glue solidifies into an elastic material. This material significantly increases the resistance to pressure in the intestine compared to the results of other types of laser treatment.

Non-absorbable sutures or stitches
Non-absorbable sutures or stitches | Source

Wound Closure Today and in the Future

The simple technique of sewing skin sections together has helped heal wounds for thousands of years. Today improved suturing materials and techniques offer a better outcome than people in the past experienced, with less scarring. Even better techniques that produce more satisfactory results - such as laser tissue welding - may soon be common. The simple stitch has served us well over time, though, and probably will continue to do so, although perhaps in a modified form.

References and Further Reading

Closing wounds with light - research from Massachusetts General Hospital

Treating wounds with a laser and a protein glue - research from Arizona State University

Optical waveguides for deep-tissue photomedicine - a report from Nature Communications

© 2012 Linda Crampton

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Comments 34 comments

Becky Katz profile image

Becky Katz 4 years ago from Hereford, AZ

This was a very interesting Hub. I knew most of the stitches but not the laser. I did not know all of the history of them though. I did know some so you just added to what I did know.

The most interesting stitches that I have ever seen were done on my dog by a vet. He got attacked by a neighbor's wolf and the wolf tore his neck open all around the back. The vet needed to put stitches in but knew that the skin would tear if they were just normal sutures. He used buttons on the outside of the skin with the sutures threaded through them. This kept the sutures from ripping the skin.

leahlefler profile image

leahlefler 4 years ago from Western New York

What a fascinating history! The army ant "suturing" technique is really interesting - though I suppose it must also be painful. I am grateful for the advent of absorbable sutures - no need to have them removed at a later date!

AliciaC profile image

AliciaC 4 years ago from British Columbia, Canada Author

Thank you for the comment, Becky. What a great idea of your vet's to use buttons with the stitches! Being attacked by a wolf must have been very scary for both your dog and for you.

AliciaC profile image

AliciaC 4 years ago from British Columbia, Canada Author

Thank you very much, leahlefler. I too am very grateful for absorbable sutures. In fact, I have some in my mouth right now, which is what inspired this hub! I certainly wouldn't want to use the ant suturing technique, except in an emergency.

wwolfs 4 years ago

Informative hub. I didn't know the history behind them and have not heard about laser. Recently, a trip to the ER with my son I found myself watching the doctor stitch a small gash under his eye. Normally, I don't like watching any stitching of the skin. He used skin adhesive and this was the first time I have seen that used. It was really amazing to watch him put the skin together without using a needle. It is true the improved techniques offer a better outcome with less scarring.

AliciaC profile image

AliciaC 4 years ago from British Columbia, Canada Author

Hi, wwolfs. It's nice to meet you! Thanks for commenting. Yes, I think that the newer ways of sealing wounds are great, especially for children. It will be interesting to see what new techniques researchers create for joining skin sections together in the future.

drbj profile image

drbj 4 years ago from south Florida

Hi, Alicia. I guess sealing a wound with army ants is acceptable if no other means are available. But I would not choose that method if I had choices. Absorbable stitches work just fine and the laser type appears to be a great solution. Excellent research ... as usual.

AliciaC profile image

AliciaC 4 years ago from British Columbia, Canada Author

Thank you, drbj. Yes, suturing a wound with ant bites would definitely be a last resort! I'm very thankful that medical professionals have absorbable stitches that they can use in appropriate situations.

teaches12345 profile image

teaches12345 4 years ago

A great educational hub on a practice we take for granted. I was fascinated reading about how ants were/are used to bind a sound. Their certainly are a number of new techniques being used today that are wonderful options for use in binding wounds. Great hub and voted up!

AliciaC profile image

AliciaC 4 years ago from British Columbia, Canada Author

Hi, teaches12345. Thank you very much for the comment and the vote. Yes, using ant bites to suture wounds is a fascinating idea, although I'm happy that the modern techniques exist!

Maren Morgan M-T profile image

Maren Morgan M-T 4 years ago from Pennsylvania

Way interesting!

AliciaC profile image

AliciaC 4 years ago from British Columbia, Canada Author

Thank you, Maren Morgan. I appreciate the comment.

prasetio30 profile image

prasetio30 4 years ago from malang-indonesia

Wow....I had never know about this before. I mean for the video....awesome. I learn many things from you. Thanks for writing and share with us. Rated up!


AliciaC profile image

AliciaC 4 years ago from British Columbia, Canada Author

Thank you for the comment and the rating, Prasetio. My best wishes to you!

Nell Rose profile image

Nell Rose 4 years ago from England

Wow! fascinating! I remember seeing the ants on tv, clever idea! I have been to the british museum and seen the history of medical equipment, some of it would give you nightmares! but this is great, detailed and interesting, nice one! rated up and shared!

thougtforce profile image

thougtforce 4 years ago from Sweden

Hi Alicia, this is a very interesting read with good information! The use of large ants is news to me and it is interesting to think about the first person who discovered that method! Well written article filled with facts about sutures, and I enjoyed reading,


mljdgulley354 profile image

mljdgulley354 4 years ago

This is a fascinating hub. We have come a long ways in the medical profession and it is good to know the history. Thank you for sharing this information.

AliciaC profile image

AliciaC 4 years ago from British Columbia, Canada Author

Hi, Nell. Yes, I've seen some early medical equipment at museums and it certainly is the stuff of nightmares! Thank you very much for the comment, the rating and the share, Nell - I appreciate them all.

AliciaC profile image

AliciaC 4 years ago from British Columbia, Canada Author

Thank you for the comment, Tina! Yes, it is interesting to think about who first got the idea of using ant bites as sutures. It sounds like a painful method of sealing a wound!

AliciaC profile image

AliciaC 4 years ago from British Columbia, Canada Author

Hi, mljdgulley354. Thank you very much for the comment. Yes, thankfully we have come a long way in our development of medical treatments!

ComfortB profile image

ComfortB 4 years ago from Bonaire, GA, USA

My daughter just finished a project that requires her using two types of suturing technique (vertical and horizontal) on disected chicken breast to see which one holds better when weight(pressure)is applied.

Let just say, that chicken died many deaths. lol.

The adhesive was used on me during a major surgical procedure, and so was the staples on another occasion. The adhessive was so much better, less painful.

Great hub, voted up.

AliciaC profile image

AliciaC 4 years ago from British Columbia, Canada Author

Thanks for the comment, the vote and the interesting information, ComfortB. Adhesive sounds like a much pleasanter technique than some of the other suturing methods. I'm so glad that it was invented!

Karanda profile image

Karanda 4 years ago from Australia

Most interesting Hub Alicia. Gosh that photo with the sutures on the back of the head - ouch. Looks horrific but the scar will probably end up paper fine.

Vote up from me too.

AliciaC profile image

AliciaC 4 years ago from British Columbia, Canada Author

Hi, Karanda. Yes, that scalp wound does look very unpleasant! Thanks for the comment and the vote.

kashmir56 profile image

kashmir56 4 years ago from Massachusetts

Hi Alicia, very interesting hub, some of it i did not know before. I just had surgery on both of my eyes and had no stitches, they have eye drops that help to heal it and keep it infection free.

Vote up and more !!!

AliciaC profile image

AliciaC 4 years ago from British Columbia, Canada Author

Thank you very much, Tom. I hope that your eyes heal quickly and that your vision is much better after your surgery!

Gracenduta profile image

Gracenduta 4 years ago from Kenya

interesting article esp, on "suturing" technique" I bet it is painfu, thanks for the hub

AliciaC profile image

AliciaC 4 years ago from British Columbia, Canada Author

Thank you, Gracenduta. Yes, older suturing techniques were probably painful. I'm glad that the modern techniques aren't!

dr ilyas khan 4 years ago

i am very glad to know about history of stiches. And different modren and old method of stiches. I am happy 4rm the bottom of heart. Thank u. Thank u and thanks

AliciaC profile image

AliciaC 4 years ago from British Columbia, Canada Author

Thank you for the visit and the comment, dr ilyas khan!

DzyMsLizzy profile image

DzyMsLizzy 13 months ago from Oakley, CA

Wow--most interesting indeed! I am a certified wuss, and eagerly await the 'Star Trek' level of medical repairs in which a non-invasive device is simply run across the wound, and presto! Instant healing! ;-)

I cannot even imagine the agony of having a wound sutured by those thick, clumsy-looking bone needles and who-knows-what kind of "thread," and before the days of anesthesia!

I had knee replacement surgery in 2013, and let me tell you, the post-op pain was nothing compared to the removal of those 26 staples!!! I'm afraid I howled like a baby! I have stated since that if I ever have to have that surgery on the other knee, that I am going to demand old-fashioned sutures, which are far less painful to have removed. (Staples just seem barbaric to me.)

But now, thanks to your article, I see there is laser wound closure, so I'll ask for that instead. ;-)

AliciaC profile image

AliciaC 13 months ago from British Columbia, Canada Author

I hope you don't need surgery on the other knee, DzyMsLzzy! Your experience sounds very unpleasant. It would be wonderful if doctors had Star Trek medical devices. Devices resembling them may be available one day. I hope they're created sooner rather than later!

calyy 5 days ago

thank you

AliciaC profile image

AliciaC 5 days ago from British Columbia, Canada Author

Thank you for the comment, calyy.

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    Linda Crampton (AliciaC)1,244 Followers
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    Linda Crampton is a teacher with an honours degree in biology. She enjoys writing about human biology and the science of health and disease.

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