Ancient Indian Surgery was a highly skilled branch of Ayurvedic medicine and known as Shalya Tantra. Eight types of surgical procedures described as "Ashtavidha Shastrakarma" are means and methods to treat the surgical diseases at that time. Suturing is not a new technique but is a known procedure since ancient era. This is the branch basically evolved for the purpose of wound healing and its management. Seevan Karma i.e. suturing is one of the prime surgical procedures and has got great importance as the success of surgery depends on careful apposition of tissues and wound healing.
Sushruta the great Indian Surgeon who had given a complete account on wound healing and various techniques of wound healing used for various types of wounds. Sushruta defined the suturing procedure as a process of tying two ends of thread for union of wound edges and is done with the help of needle & appropriate suturing material.
The purpose of seevan karma is to approximate the wound edges for proper and faster healing i.e. Vrana Sandhan. Sandhan means to unite, to heal. Aim is to unite, repair and support the injured tissue until healing is completed. This will achieve complete haemostasis and normal restoration of tissue function.
With advancement of time, science is expanding its wings in every field. But basic principles remain always unchanged. That's why modern surgery also follows all those ancient surgical principles. Acharya Sushruta had described in details about how to perform suturing in a proper way avoiding complications. Those principles are as follows: -
Wound Preparation: -
Before suturing the wound, it should be cleaned thoroughly. The devitalized tissue or any foreign material like dirt, dust, hair, sequestrations of bones, clotted blood all need to be removed from the wound. This will reduce the chances of sepsis. Then the detached parts of tissues, fractured bones are placed in their normal position. Achievement of complete haemostasis is confirmed and wound is stitched with suture material inserted in a needle.
Importance Of Debridement & Cleaning The Wound: -
The most important steps in the prevention of infection in a traumatic wound involve preparation, irrigation, and debridement. The importance of meticulous wound care cannot be overemphasized. All devitalized tissue needs to be removed so that possibility of infection is markedly reduced.
The process of wound infection and its disadvantages were not unknown to ancients. Sushruta has clarified that blood clots, foreign materials like stones, hair, nails, fragment of fractured bone etc should be removed and wound should be thoroughly cleaned and then apply suture. If these materials are not removed, the wound will proceed to Pakavastha i.e. suppuration and will increase pain over affected part.
Wound Closure In Layers: -
During closure, every attempt is made to match each layer evenly and produce a wound edge that is evenly matched. Acharya Bhoj insisted to close the wound in layers to enhance wound healing.
Chakradatta elaborated this principle as, while suturing the wound it should be closed in layers i.e. muscle-to- muscle and skin-to-skin.
Methods Of Wound Closure (seevan karma): -
Four methods of suturing techniques are described in ancient texts as seevan karma-
- 1. Riju granthi - straight, interrupted type
- 2. Vellitaka - continuous type
- 3. Tunnasevani - zigzag type or subcuticular
- 4. Gophanika - interlocking or blanket type suturing.
Vellitaka i.e. round. This is achieved by suturing continuously along the length of the wound rapping the wound edges inside it.
Tunnasevani is done as like as the torn up garments are sutured.
The wounds which are shaped as footprints of crow, they are sutured with gophanika type of suturing.