The History of Knots and Surgical Suturing

Abstract

As one of the oldest materials used by human, many evidences show that ropes are closely related to human evolution. Due to perishability, few ropes remain intact after thousands of years. Even if there are few intact ropes found, most of them are collected in museums. Therefore, ropes may be “the most remarkable invention of human.” One piece of fiber is of no use. But when these fibers are spun into yarns, yarns are twisted into strands, and strands are woven into ropes, such a trivial thing will become strong and flexible, creating unlimited possibilities.

Long time ago, our ancestors collected grass, vines, and bamboo and twisted them into a knot to thread through, tie up, and bundle up fruits and prey. These knots are the most original ones. As early as the end of the Paleolithic Age, the remains of the Caveman culture in Zhoukoudian were found to have “bone needles.” Since needles appeared at that time, there might have been threads and ropes, from which we can infer that the simple techniques of knot tying and sewing should have begun to take shape.

The earliest records of surgical suture can be traced back to 3000 B.C. in ancient Egypt, where a Greek physician Hippocrates, known as the “Father of Medicine,” described the basic suture technique. Surgical sutures have evolved from plant-derived materials (flax, hemp, and cotton) or animal-derived materials (hair, tendons, arteries, muscle strips or nerves, silk, catgut) or animal body parts (ant’s head and mandibles) to metal materials (silver, copper, aluminum, and bronze wires) to various synthetic materials in nowadays.