When the very first surgeries were performed, wound closure wasn’t an issue. The surgeons often left the incisions open with the hope that they would close by themselves over time. Scarring was rarely a problem because these very first patients often didn’t survive the post-operative period, usually as a result of infection.
The earliest sutures were animal hair, bristles and tendons, flax, hemp and a variety of other “threads.” The needles were made of bone. Medical professionals back then also used various gums, resins and other sticky materials. The high tech few would allow beetles or ants to bite the incision closed and then decapitate the insects leaving the jaws to hold the incision.
We have come quite a way since then but basically we still use sutures, adhesives and staples. The goals of closing incisions are to reduce the risk factors associated with infection, fluid loss and scarring. Some patients are more prone to scarring than others but surgical technique and the avoidance of infection are also important.
Infection comes from bacteria, sometimes acquired in the hospital but often brought in on the patient’s own skin. The goal is to keep these bacteria from multiplying and changing an inevitable contamination into a clinical infection.
We have learned that there are several ways to address the risk factors associated with infection. Proper skin preparation, a warm environment during surgery, good oxygenation, appropriate prophylactic antibiotics, proper hair removal, and good glycemic control have all been demonstrated to reduce infection.
More recently antibacterial devices have become available. Catheters, orthopedic devices and sutures are now available with antibacterial features that inhibit colonization of bacteria that might otherwise accumulate on them and progress to a clinical infection. Skin adhesives used as a final layer of closure can offer a microbial barrier.
These measures have little or no risk and add little or no cost to the procedures.