Living for a Suture

August 11, 2009 § 4 Comments


This weekend I did something I seldom do. I sewed a large patch on one of my jackets (photo credit). Over 500 stitches by hand. And while I was sewing I thought about suturing.

Before I started filming and photographing surgery I didn’t know that suturing was such a large part of many operations. And I certainly didn’t find it interesting. The first suture-related thing that fascinated me was surgical staplers. I had never seen one before I saw a GIA being used in a low anterior resection. I thought it looked like a space age instrument, and it looked so incredibly easy and state-of-the-art. That was before I saw an end-to-side bowel anastomosis done by hand. Done by an expert it can be a mesmerizing thing to watch.

Anastomoses are still fascinating (how can you keep an artery blood-tight with just a few stitches?), but what I find most beautiful in suturing is delicate plastic facial sutures, done only in the fascia – making it hard to see the wound even just after closure.

I thought about these things as I mended my favorite jacket. I was glad I didn’t have to do this everyday. The thread slipped out of the needle (there was a time when they had to thread the suture by hand too), I pricked my fingers all the time, the thread snapped and so on. But after a few hundred stitches I started too feel a certain satisfaction in the handycraft. I even redid a few stitches I wasn’t happy with. It must have been a huge leap forward for general surgeons when the surgical stapler was introduced, but now I understood those surgeons¬† looked at each other, said “let’s do this one by hand,”and made the anastomosis with obvious joy.

I finished the jacket in about two hours, and then the thread took an unexpected direction.

A South American army ant soldier. Click for larger version. Photo by Hayes Cummins, Miami University. Used with kind permission.

A South American army ant soldier. Click for larger version. Photo by Hayes Cummins, Miami University. Used with kind permission.

The next day I was watching a BBC documentary about swarms in nature. One insect that goes on collective food raids periodically is the African driver ant. Over 50 million ants can march out from the ant hill and kill as many as 100,000 insects in one raid. The large soldiers line up to form a sort of corridor wherein the smaller workers can pass safely. Very interesting in itself, but as my stitching sent me roaming the interwebs for some history of surgical sutures, I discovered a connection!

One of the oldest suturing techniques known to man involved these driver ants and their American counterparts, the army ants. For small skin wounds (and even some bowel wounds) they would take an ant soldier and make it bite the skin on each side of the wound with their huge pincer-like mandibles. Then they would twist off the body, leaving only the head with the mandible fixed. More ants would be applied further down the wound until it was closed.

The organic staples are still used by some African and South American tribes. But not for jackets, I guess.



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