Max Sänger - father of the modern caesarean section

The major turning point in the development of the caesarean section appeared in 1882, when the German gynaecologist Max Sänger (1853-1903) suggested closing the uterine wound. Until this point, the wound was not sutured and so haemorrhage was a common cause of maternal death. Sänger's method quickly became standard, leading to a spectacular drop in maternal mortality. Sänger was one of the most renowned German gynaecologists at the end of the 19th century. He contributed to the entire fields of obstetrics and gynaecology, in particular in founding Monatsschrift für Geburtshülfe und Gynaekologie, the predecessor of this journal.

[History of mechanical sutures in digestive system surgery]

The attempts to suture wounds with mechanical device are very old, and their history is lost in the night of times. But more recently--that means less than two century ago--already before the true initial beginning of the modern surgery, after the birth of anaesthesiology with the "ether day--16 october 1846" there have been many efforts to develop new methods to join the tissue of the gut avoiding the danger of peritoneal contamination. The primitive tools of these ancient stapler were founded on the principle to compress with mechanical devices the two sides of the tissue to join. Very early in the past century, well before the appearance of the antibiotics, in the heart of the old Europe were developed and perfectionated devices able to join the intestinal tissue with metallic stitches: the primitive staplers. But after the end of the second world war the development has become bursting, with the progress of the Sovietic Institute of experimental research on surgical tools of Moscow and then with the mighty initiatives of the industrial power in the USA. The more important progress in this field was founded on the standardization of tools designed to fix metallic stitches on the gut, but very recently there are new attempts to use the more old principle of compression-suture on new basis. The results of this development, essential for modern surgery, are the standardization of the surgical technique, the shortening of operative times, and an important support to the new mininvasive approach to digestive surgery.

[History of meniscus surgery. From excision of joint loose bodies to meniscus suture]

In comparison with other operative procedures, the history of meniscal-surgery offers some particular differences. Over a long period of time injuries of the semilunar-cartilages of the knee-joint were not generally recognised. In the 18th century only was the clinical picture roughly outlined. There is evidence, that parts of the meniscus were removed much earlier than we have historic proof of. These meniscal fragments were generally mistaken for "loose bodies" in the joints, not knowing the exact etiology. Operative interference with joints was afflicted with a very high incidence of infections and thus complications. Due to this reliable standards of sterility were imperative to obtain reproductive and satisfactory results in surgery of the knee-joint and this is why the discovery and implementation of antiseptic and aseptic principles play such an important role in joint- and, in particular, in meniscal-surgery. The development of meniscal-surgery is dominated by a lengthy discussion about the way in which the injuries of the semilunar cartilages should be dealt with operatively. Fundamental techniques such as fixation of the cartilage by sutures, limited or total removal of the meniscus were established as early as 1895. Over a long period they existed concurrently and their adequate application remained cause for a highly controversial discussion until the end of the 20th century. Not before more detailed knowledge was gained about the exact morphology of the meniscus and the rising of arthroscopic surgery offered new surgical perspectives, it was possible to establish a widely accepted standard of meniscal surgery.

[Ramdohr invagination operation and its significance for development of intestinal suture technique]

The development of the modern intestinal suture began with the invagination operation, performed by the German surgeon P.F. Ramdohr in Wolfenbüttel in 1727. Today this fact is largely forgotten. Yet this operation stimulated not only Jobert de Lamballe (1824) but also Lembert (1826) to perform their animal experiments on sutures in the intestine. Also all later modifications of these suture techniques took into consideration the principle of invagination.

[From Murphy's button to the Valtrac Ring. 100 years in search of a paradigm]

In the context of continuous development in the area of anastomotic sutures leading to exceptional results in surgical practice, the biofragmentable anastomosis ring (BAR) described in 1985 by Hardy et al. represents a breakthrough in a 100 years' search of a paradigm. The first anastomotic button created in 1892 by J.B. Murphy was at once accepted as a quick and safe method of intestinal anastomosis. In 1896 Czerny demanded the following: "The task of technology is ... to create buttons with material that is entirely or partly dissolved in the intestinal lumen." Polyglycolic acid--developed in the sixties and now in widespread use for resorbable surgical sutures--was the material to fulfill the requirements already stated in the relevant literature 100 years ago, namely in the form of Hardy's BAR, which represents a redesigned Murphy button exploiting the recent biotechnological developments of this century.

[History of healing; wound suturing]

The history of wound suturing reflects that of surgery itself. In wound treatment, which encloses the technique of suturing as well as suturing materials, wound suturing plays a prominent role. In ancient India, Egypt and the Greek and Roman societies wound treatments as well as suturing techniques and instruments were developed that strongly resemble those in our days. Catgut and silk are known since antiquity. Hardly any progress is noted up to the nineteenth century. The debate on closed or open wound treatment has never stopped. The improvement of catgut by Lister started in 1860. In the 19th century prototypes of mechanical suturing instruments (staplers) were developed. They were introduced into clinical practice in the early decades of the 20th century. The greatest progress in wound suturing started after World War II with the introduction of advanced semiautomatic stapler machinery and with the manufacture of synthetic non-resorbable and resorbable fibres. They have revolutionized surgery and were instrumental in developing new fields (microsurgery).

Cemil Topuzlu Pacha and his arterial suture technique

Cemil Topuzlu Pacha (1868-1958) is known to be one of the most famous surgeons in Turkey through the early decades of the twentieth century. Being a talented and courageous surgeon, he performed many of the avoided operations of that time. He presented his vascular suture techniques at the International Medical Congress in Moscow in August 1897 and at the annual Congress of the Societe de Chirurgie de Paris in July 1904. He reported 2 cases of arterial tear during breast carcinoma resection and repair within the same session. He also reported the removal of a pen cover from the right main bronchus of a 7-year-old girl through a tracheotomy in 1903. He worked for 3 years with the famous French surgeon Jules Pean and became a preferred surgeon of the Ottoman Imperial family in Istanbul. He was admired for his scientific studies in international congresses and was one of the first Turkish surgeons who became a member of important European surgical associations.

David R. Boyd Lecture in Trauma Care and Emergency Medical Systems: upper extremity injuries--past, present, and future

Since its recognition as a subspeciality soon after World War I, hand surgery has evolved into a highly specialized and sophisticated field of medicine. Enormous advances have been made in the diagnosis and treatment of disorders of the upper limb; primary tenorrhaphy and the application of microsurgical techniques for revascularization, replantation, and free tissue transfer are among the most important innovations. This article reviews the history of flexor tendon surgery and reconstructive microsurgery up to the present time, and makes some predictions for the future direction of these, and other, areas of hand surgery.