Laudable Pus, Cocaine, and the Evolution of Wound Management

To review the long history of wound management, including the methods of skin closure, asepsis, and anesthesia. Periocular techniques will be emphasized.

Literature searches and cross-referencing were used to identify historic reports addressing the management of wounds. Foreign language manuscripts were translated using online resources.

The first written description of suturing dates to around 3000 BC and involved the repair of an eyebrow wound. A wide variety of materials have since been used as ligatures or stitches, including animal intestines, tendons, hair, silk, linen, plant fibers, and metal wire. For much of recorded history, sutures were a primary cause of wound infection and morbidity. There was a time when the resultant drainage was viewed as being beneficial (laudable pus). Many of the discoveries that ultimately led to the practice of asepsis were coincidental. Prior to the development of infiltrative anesthesia in 1894, patients had to endure the discomfort of surgery, occasionally with the sedative effects of wine or cannabis.

The history of wound closure is a fascinating tale. While there has been a constant evolution, silk and catgut sutures, ligatures, surgical knots, and layered closure have been used for several millennium. Advances in asepsis, in addition to the development of anesthesia, antibiotics, and synthetic sutures, ushered in the modern age of surgery. A knowledge of the past will give us, as oculofacial surgeons, a greater understanding and appreciation of the techniques we use today.