[History of the techniques of obtaining skin]

The history of skin gaining techniques, concerns suture, skin extension and skin expansion. Although, for a very long time, suture and skin extension were intimately related and constitute the basis for current techniques, it was only from the second part of the 20th century that skin expansion was developed and that skin extension was submitted to specific studies.

[1896-1996: a century of cardiac surgery. Ludwig Rehn and the first heart surgery]

In 1896 Stephen Paget published his book "Surgery of the Chest", where he affirmed that heart surgery had probably reached the limits of nature for any kind of surgery. This statement followed Billroth's who, few years earlier, sustained that the surgeon who attempted a suture of a wound in the heart was sure to loose forever the consideration of his colleagues. However, that very year of 1896 in Frankfurt, Ludwig Rehn succeeded in suturing a stab wound of a man's heart. By accomplishing this, he not only proved his colleagues wrong, but he made the heart, center of life and site of the soul, accessible to the surgeon, opening the way to what is today cardiovascular surgery.

A historical perspective on meniscal repair

The treatment of meniscal injuries has changed drastically over the past 50 years. This evolution has been fueled by research on the natural history, basic science, and biomechanics of meniscal injury and by the advent of arthroscopy. This article presents a brief overview of these developments.

[A case of surgical ligature of the sacro-iliac joint from Renaissance Central Italy]

The paper reports a case of interbone ligature between the sacrum and right ileum using copper wire in an adult woman whose skeleton, dating from approximately 1600-1700 A.D., was exhumed from the Church of Sant'Egidio in Borrello (Chieti). Having described the ligature and the techniques used, the Authors discuss the reasons for the operation. In conclusion, it is suggested that the most plausible hypothesis is that it represent an interbone ligature during the course of autopsy to allow the recomposition of a corpse with a sacro-ileal dislocation. The absence of signs of sacro-ileal dislocation caused by mechanical levers during the course of autopsy leads the Authors to suppose the sacro-ileal rupture occurred while the subject was still alive. The Authors therefore hypothesise that the woman died while giving birth following the laceration of the pubic symphysis and rupture of the right sacro-ileal joint. The hypothesis of a corpse restoration is also suggested.

A view of the development of intestinal suture. Part II. Principles and techniques

During the 19th century, the principles of suturing and operating upon the bowel were developed. Lembert published his technique, emphasizing the importance of the serosa in 1826. This brought about sudden transition from the ancient methods of intestinal surgery. Considerable controversy followed. Dieffenbach reported the first clinical success with this suture in 1836. Lister introduced aseptic sutures and the principles of antisepsis to the intestine which allowed the subsequent developments. The importance of the submucosa in anchoring a stitch, so that divided surfaces could stay opposed, was drawn to surgeons' attention by Gross and by Halsted. Mall described the histologic changes and pointed out that necrosis would occur if sutures were too close or too tight. More than 200 modifications were described by the beginning of the 20th century. During the 1950s, everting suture was compared with inverting anastomoses, and the safety of this method was realized.

A view of the development of intestinal suture. Part I. From legend to practice

This article outlines the early steps of developing intestinal suturing. Intestinal suturing was discussed but not performed by Celsus, Galen and Susrutas. The legendary story of the suture of the Four Masters began in the 13th century. The first recorded successful intestinal suture was by Saliceto in 1275. Very little progress occurred until the 19th century but Duverger, in 1757, reported success with the Four Masters' suture. The Glover's continuous suture of the artisans was applied to the intestine. Modifications followed and those of Petit, Bell and Larrey are mentioned.

The operation of Bassini as described by Attilio Catterina

The book entitled, "The Operation of Bassini" by A. Catterina made the greatest contribution to the understanding of the details and technique of the Bassini hernioplasty. The 16 colored figures are reproduced for the first time as far as can be ascertained in North America. For unknown reasons, the book was never published in North America, leaving the surgeons of North America ignorant of Bassini's intentions. Bassini's own descriptions were brief and subject to misinterpretation and his illustrations were not detailed enough. The description given by Andrews of his personal observation of Bassini operating should have, but did not, enlighten North American surgeons. The inguinal hernioplasty of the Shouldice Hospital evolved de novo but is, in fact, the modern equivalent of the Bassini procedure.

A century's worth of arterial sutures

In light of the advanced state of vascular surgery today, it is hard to realize that the technique of vascular suturing is barely 100 years old. Even more remarkable is the skill with which the early surgeons applied almost all of the techniques we use today. Eck's experiments in the laboratory with portal vein-to-vena caval anastomoses were followed by pessimistic predictions concerning the future of arterial sutures. Jassinowsky had just performed the first successful arterial suture when he did a clinical arterial repair and, within 15 years, Carrel had developed nearly all the technical maneuvers which we use today. Knowledge of Carrel's work spread rapidly, and practical application of his work was reflected in the development of vascular replacements, such as venous grafting, the bypass technique used for vein grafts before World War I. There was, however, a lag in further developments until the end of the forties when dos Santos and Kunlin revived old methods and opened the way for further arterial surgical advances. These early developments are well-documented, but the reasons for delaying the acceptance of their applications remain a matter for speculation.

[Development of suture materials: from the beginning to our day]

The history of suture materials from the beginnings to the II World War is reported. In this period, catgut and silk were the most employed sutures. The appearance and successive development of synthetic materials revolutionized the field of surgical sutures. This evolution is still active, to the search of ideal suture line.