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There are two essential differences in the technical use of silk and of catgut suture material. With the former it is important to employ interrupted sutures throughout and desirable to sever the suture close to the knot. The significance of employing interrupted sutures is twofold: 1. Silk sutures in the presence of secondary infection may act as an irritant or foreign body, and if continuous sutures have been used the suture produces a pathway for the further extension of this infection. The infection (particularly the chronic, relatively avirulent type) and irritant factors may produce insidiously a granulomatous type of lesion. Silk and, more recently, cotton are employed as a routine in the Tulane Surgical Service. Although at present interrupted sutures are used entirely, with no complications, continuous sutures were used very early in the adoption of the all silk technic. During this period several cases were observed in which granulomatous
DeBakey M. NEW SUTURE SCISSORS. JAMA. 1939;112(23):2410. doi:10.1001/jama.1939.62800230001012
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