Personal Surgical Log
A running record of every tie and technique — where you are with each one, and the notes you want to remember for next time. Tap a status to move it forward.
Reference · read once, revisit as needed
Closing a wound with thread is one of medicine's oldest procedures. Egyptian wound care is described in the Edwin Smith Papyrus, usually dated to around 1600 BCE, and in ancient India the surgeon Sushruta (his compendium is commonly placed around 600 BCE) wrote detailed accounts of suturing — including the striking trick of letting large ants or beetles bite across a wound, then twisting off the bodies so the mandibles held the edges like clamps.
For most of that history the material was whatever was strong and available: linen, flax, hair, tendon, silk, and catgut — which despite the name comes from the intestinal wall of sheep and goats, not cats. The Greek physician Galen (2nd century CE) described catgut ligatures, and variations on it stayed in use for well over a thousand years.
The turning point was infection control. In the 1860s–1880s Joseph Lister applied antiseptic principles to surgery and treated catgut so it was both sterile and more predictable in how it dissolved — a genuine leap in safety. The 20th century then replaced natural materials with engineered ones: polyglycolic acid (Dexon) arrived around 1970, followed quickly by polyglactin 910 (Vicryl), and then a family of monofilament synthetics — polypropylene (Prolene), nylon, polydioxanone (PDS), poliglecaprone (Monocryl). A quieter but important advance was the swaged (eyeless) needle, where the thread is bonded directly into the back of the needle so it pulls through tissue in a single smooth pass instead of dragging a doubled strand through an eye.
Knot-tying is just as old. The flat, secure square knot (reef knot) and its stubborn cousin the slipping granny knot long predate surgery; what medicine added was the discipline of laying throws flat and squaring them so a knot holds under a body's movement. That principle — a knot is only as good as the throw beneath it — is the same one you're drilling in the log below.
There's no single "best" suture — you match the thread and needle to the tissue, the tension, the cosmetic stakes, the infection risk, and whether the stitch will ever be removed. Four decisions cover almost everything.
Absorbable sutures break down in the body (by hydrolysis or enzymatic digestion) over days to months. Use them where you can't or won't come back to remove a stitch — deep and buried layers, mucosa, and closures in children. Common ones: Vicryl, Monocryl, PDS, and plain/chromic gut.
Non-absorbable sutures keep their strength long-term. Use them for surface skin closure (removed later), or where lasting support matters — tendon, vessel, some fascia. Common ones: nylon (Ethilon), polypropylene (Prolene), silk, polyester.
Monofilament is a single smooth strand: it slides through tissue with little drag and gives bacteria few places to hide, so it's the safer choice in contaminated wounds — but it's stiffer, has more "memory," and needs extra throws to keep a knot from slipping. Braided (multifilament) handles softly and ties down securely, but its woven surface drags more and can wick and harbor bacteria, so it's avoided in dirty fields.
Counter-intuitively, more zeros means thinner thread: 5-0 is finer than 4-0 is finer than 3-0. Bigger, higher-tension structures want a thicker (lower-number) suture; delicate, cosmetic areas want fine thread that leaves less mark.
| Site | Typical size |
|---|---|
| Face | 5-0 to 6-0 |
| Scalp | 3-0 to 4-0 |
| Trunk / arms | 3-0 to 4-0 |
| Hands / feet | 4-0 to 5-0 |
| Deep dermal | 4-0 to 5-0 absorbable |
| Fascia | 0 to 1 |
General starting points — follow your program's preference and the specific wound.
Two things to read on a needle: its curve and its point. A 3/8-circle needle suits open skin; a 1/2-circle turns tighter in a deep or confined space. The diagrams below are cross-sections — a slice through the needle tip — with the wound/tissue plane shown as the dashed line.
| Tip | Point | Use |
|---|---|---|
| Reverse cutting | Skin — the sharp edge faces the outer curve, away from the wound, so the stitch resists tearing through | |
| Cutting | Tough or fibrous tissue — same triangle, but the sharp edge faces inward, toward the wound | |
| Taper | Soft tissue, fascia, bowel, vessel — round body with no edge; it spreads fibers apart rather than cutting them | |
| Blunt | Friable tissue; the rounded tip pushes through without cutting and lowers needlestick risk |
Reading the shapes: a triangle means a cutting edge (for tough tissue), and the orange tip shows which way it faces — out (reverse cutting) or in (cutting). A round body has no edge and spreads soft tissue: taper comes to a point, blunt is rounded.
Suture packaging is colour-coded by material, which is where this journal's status colours come from:
| Violet | Vicryl / PDS (absorbable) |
| Blue | Prolene (polypropylene, non-absorbable) |
| Black | Silk or nylon |
| Undyed | Monocryl / plain gut |