Silk, Catgut, and Wound Infections *

Whether absorbable or non-absorbable suture material should be used in the repair of wounds has long been a highly controversial subject. Popular favor has swung from one extreme to the other repeatedly in the last century. Lord Lister was responsible for the initial popularity of catgut, just as Kocher was one of the first to abandon its use in favor of a non-absorbable material, i.e., silk. Halsted is generally recognized as the first great proponent of the non-absorbable suture, and is rightfully considered the founder of the present-day silk technic. The story of the changing trends in wound closure is a fascinating one. Most of the modern literature presents a very convincing brief for the use of a non-absorbable material, whether it be silk, cotton, alloy steel, or one of the newer synthetics. Howes, Jenkins, and Bower and his associates have been almost alone in the defense of catgut, though McKittrick, in a discussion of wound healing following amputation, showed results demonstrating fine catgut to be equal or superior to silk. Despite the paucity of literary support, it is safe to say that throughout the country catgut is used at least ten times as often as is the entire non-absorbable group. Habit and a sort of surgical superstition are probably more responsible for this state of affairs than is any rational approach to the problem. It must be admitted that the fear of burying a suture which will not be absorbed is still present in the minds of most surgeons. Not long ago the author heard a well-trained surgeon remark that the use of alloy steel wire for wound closure seemed like a return to the dark ages. Undoubtedly there is a natural reluctance to permit foreign bodies to become permanent guests of the human body. If and when an ideal material is developed, it will necessarily combine the best features of the materials in use today, possessing the absorbability of the one and providing the constant tensile strength and the minimal tissue reaction of the other. Many papers have been published to demonstrate the superiority of silk, cotton, or steel wire over catgut and the results quoted can-