The earliest known references to stitching wounds shut date back roughly 3,500 years, to ancient Egypt. But the practice is almost certainly older. The Edwin Smith Papyrus, written around the 17th century B.C., describes treating deep stab wounds and injuries by binding them with fresh meat and other dressings. While this document focuses more on wound management than suturing technique, it confirms that Egyptian physicians were already closing and treating traumatic wounds with sophisticated, step-by-step protocols thousands of years ago.
Ancient India: The First Detailed Suture Techniques
The most detailed early account of surgical stitching comes from ancient India. Sushruta, a physician who likely practiced around 600 B.C., described suturing with remarkable precision in his medical text, the Sushruta Samhita. He used horsehair, plant fibers, and silk to sew wounds closed, and he documented different needle types designed for different situations. His techniques included interrupted stitches for deep wounds, continuous stitches for strength and stability, and even interlocking and zigzag patterns. He also emphasized cleaning wounds with antiseptic herbal preparations before closing them, a concept that wouldn’t become standard in Western medicine for over two thousand years.
Roman Surgeons and the Rise of Catgut
Galen of Pergamon, the influential Roman physician who practiced in the second century A.D., described using both silk and catgut to close battle wounds. Catgut, despite the name, was made from the intestines of sheep or other animals, twisted and dried into thin threads. What made catgut significant was that the body could gradually absorb it, meaning the stitches didn’t need to be removed. This material would remain the standard absorbable suture for the next 1,800 years.
The 1500s: Paré Replaces Hot Irons With Thread
For centuries, the standard way to stop bleeding during surgery was cauterization: pressing red-hot metal against the wound. It worked, but it destroyed surrounding tissue and dramatically increased infection risk. In 1564, French military surgeon Ambroise Paré published a method that changed the field. Instead of burning blood vessels shut, he tied them off with thread, a technique called ligation. He used fine linen strips and silk to constrict severed arteries and veins, which preserved the skin flaps needed to cover amputation sites and gave patients a far better chance of healing. Paré candidly admitted that his new approach made his earlier recommendation of cauterization obsolete.
The Antiseptic Breakthrough
For most of history, stitches saved lives by closing wounds but also introduced a serious risk: infection. Surgeons sewed with unsterilized thread using unsterilized hands. That began to change in 1867, when Joseph Lister pioneered the idea of antiseptic surgery. By 1869, he had developed sutures soaked in carbolic acid, an antiseptic compound, and later introduced chromic catgut, made from sheep intestine treated with chromic acid to slow absorption and resist infection. The results were transformative, though perfecting catgut sterilization took another 40 years of experimentation with chemical baths, steam exposure, and combination techniques.
Through the 1930s, catgut remained the go-to absorbable suture material, while silk and cotton served when surgeons needed stitches that wouldn’t dissolve.
The Eyeless Needle
One deceptively simple invention in the 1920s made a major difference in how much damage stitches caused to tissue. Scottish pharmacist George Merson developed eyeless needled sutures: a single strand of suture material pre-attached through the back end of the needle, rather than threaded through an eye like a sewing needle. Traditional eyed needles pulled a doubled-over thread through the skin, tearing a wider path. Merson’s design cut that trauma roughly in half. This is still the standard needle design used in surgery today.
Synthetic Sutures and Modern Alternatives
The mid-20th century brought the first synthetic suture materials, which could be engineered for predictable strength, absorption time, and reduced tissue reaction in ways natural materials couldn’t match. Surgeons gained precise control over how long a suture would hold before the body broke it down, which mattered enormously for internal surgical sites that couldn’t be revisited to remove stitches.
The 20th century also introduced two alternatives to stitches entirely. In 1908, Hungarian surgeon Hümér Hültl and engineer Victor Fischer invented the first surgical stapler, a device that could close wounds with metal staples far faster than hand-stitching. And in 1998, the FDA approved Dermabond, a medical-grade skin glue based on cyanoacrylate (the same family of chemicals found in superglue, but formulated for safe use on skin). Surgical glue works well for smaller, low-tension cuts where stitches would be overkill.
The basic concept of pulling a wound’s edges together with thread has survived essentially unchanged for at least 3,500 years. What has changed is everything around it: the materials, the sterilization, the needles, and the understanding of infection. A suture placed today bears little resemblance to horsehair pulled through a wound in ancient India, but the underlying principle is identical.