Knowing When to use each type of stitch for optimal wound care

September 27, 2025 •

4 min read

Approximately 12 million emergency room visits each year are due to injuries requiring stitches or other wound closure methods. Understanding When to use each type of stitch is critical for medical professionals to ensure proper healing and minimize complications for patients.

Quick Summary

Stitches, also known as sutures, are chosen based on a wound's depth, location, and the underlying tissue type, with absorbable types dissolving naturally and non-absorbable ones requiring removal.

Key Points

Absorbable vs. Non-Absorbable: Absorbable sutures are for internal tissues and dissolve over time, while non-absorbable ones are for skin and must be removed.
Simple vs. Continuous Stitches: Use simple interrupted stitches for secure, precise closures and continuous stitches for fast, sealed closures on longer wounds.
Minimizing Scars: Subcuticular sutures, placed beneath the skin, are used for wounds where minimizing visible scarring is a top priority.
High-Tension Closure: Mattress sutures provide extra strength and help evert wound edges, which is essential for wounds under high tension.
Wound Assessment is Key: The right stitch choice depends on a professional assessment of the wound's depth, location, and the surrounding tissue.
Material Matters: Suture materials, whether braided or monofilament, are chosen based on their strength, flexibility, and how they react with tissue.

The Fundamental Types of Sutures

Absorbable Sutures

Absorbable sutures are designed to be broken down and digested by the body's tissues over time through enzymatic hydrolysis. This eliminates the need for a follow-up visit to have them removed, making them ideal for internal use. These are commonly used for closing deep layers of tissue, internal organs, and mucosal areas, such as inside the mouth. Examples of absorbable materials include:

Polydioxanone (PDS): A monofilament suture known for its extended holding strength, making it useful for slow-healing tissue.
Polyglactin 910 (Vicryl): A braided suture that is strong initially but loses strength more quickly, often used for fascia and ligatures.
Poliglecaprone (Monocryl): A monofilament suture frequently used for closing the skin subcutaneously, resulting in minimal scarring.
Chromic Gut: A natural, rapidly absorbing suture used in areas where rapid healing occurs, such as mucous membranes.

Non-Absorbable Sutures

As the name suggests, non-absorbable sutures are made from materials that the body cannot metabolize. They must be removed manually once the wound has healed sufficiently. These are used to provide long-term wound support or in areas that heal slowly. They are the preferred choice for skin wounds, as well as for repairing tendons, ligaments, and in cardiovascular procedures. Common non-absorbable materials include:

Nylon: A synthetic monofilament suture known for its high tensile strength and elasticity, commonly used for skin closure.
Polypropylene: A strong, inert monofilament suture used in both skin and cardiovascular surgery due to its low tissue reactivity.
Polyester: A braided suture known for its high strength, often used in orthopedic and general surgery.
Silk: A natural, braided suture that was once common but is less so now due to its potential for tissue reaction.

Choosing the Right Stitching Technique

Beyond the suture material, the technique used to apply the stitches also depends on the wound's characteristics and the desired outcome.

Simple Interrupted Stitches

This is one of the most common and versatile techniques, involving individual knots tied for each stitch. This method is used for closing skin, subcutaneous layers, and other tissues. The advantages include precise wound edge alignment and high security, as the failure of one knot does not compromise the entire closure. It is, however, more time-consuming to place.

Continuous (Running) Stitches

In this method, a single, continuous strand of suture is used to close a wound with a running series of loops. It is much faster to place than interrupted sutures and provides an excellent seal, which is useful in surgical procedures where a watertight closure is needed. A potential drawback is that if the suture line is broken, the entire wound could open.

Subcuticular Sutures

This technique involves placing absorbable sutures just below the skin's surface in a continuous fashion. The entire suture is buried, with no external stitches to be removed. It is the gold standard for achieving the best cosmetic results, as it leaves very little scarring on the skin's surface. It requires precise technique and is best for clean, linear incisions with minimal tension.

Mattress Sutures

Mattress sutures are designed to evert (turn outward) the wound edges, which helps in better healing and reduces the likelihood of a depressed scar. There are two main types:

Vertical Mattress: Provides strong, everting closure for deep wounds and wounds under high tension.
Horizontal Mattress: Useful for closing wide wounds and ensuring excellent eversion along the wound edge.

Comparison of Suture Types and Techniques


Feature	Absorbable Sutures	Non-Absorbable Sutures	Simple Interrupted	Subcuticular	Mattress
Material	Natural or synthetic	Synthetic (Nylon, Polypropylene)	All types	Absorbable monofilament	Non-absorbable, monofilament preferred
Dissolves?	Yes	No	No (for external)	Yes	No
Primary Use	Internal tissues, subcutaneous layer	Skin, tendon repair	Common skin closure	Aesthetic skin closure	High-tension wounds
Removal Required?	No	Yes (for skin)	Yes	No	Yes
Aesthetic Result	N/A (Internal)	Good (if removed on time)	Good (but can leave tracks)	Excellent	Good (strong closure)

The Critical Role of Wound Assessment

Medical professionals must assess several factors when deciding on the appropriate wound closure. The depth of the wound, the type of tissue involved, the amount of tension on the wound edges, and the patient's cosmetic concerns all play a crucial role. For more detailed information on appropriate techniques and safety in surgical settings, clinicians can consult official resources. For more in-depth guidance on surgical procedures, consult the World Health Organization's surgical safety guidelines.

Conclusion: A Case-by-Case Decision

Ultimately, there is no single right answer to when to use each type of stitch. The selection of suture material and technique is a nuanced decision based on a comprehensive assessment of the wound and patient needs. While absorbable sutures offer convenience for internal wounds, non-absorbable options provide the strength needed for critical skin closures. Simple interrupted stitches remain a versatile staple, while specialized techniques like subcuticular and mattress sutures are reserved for specific cosmetic or high-tension requirements. Only a qualified medical professional can properly determine the best course of action for any given wound. Attempting self-closure is not recommended and can lead to serious complications and infection.

Frequently Asked Questions

The main difference is that absorbable sutures are broken down and absorbed by the body over time, whereas non-absorbable sutures are made of a material that the body cannot metabolize and must be removed manually.

Doctors consider several factors, including the wound's depth, location, the tissue involved, the amount of tension on the wound, and cosmetic considerations, to determine the most appropriate suture material and technique.

The need for stitches versus other closures, like adhesives or staples, depends on the wound's severity. Deep, wide, or jagged cuts generally require stitches, while minor cuts may be treated with adhesive strips or glue.

Subcuticular stitches are a type of closure where the suture is placed just beneath the skin's surface in a continuous pattern. They are used to achieve the best cosmetic result by minimizing visible scarring.

The time non-absorbable stitches remain in place varies depending on the wound's location. For example, stitches on the face may be removed within 3-5 days, while those on the back or over joints may stay in for up to 14 days.

While rare, it is possible to have a reaction to suture material. This is one reason why non-absorbable sutures are preferred for patients with known sensitivities, as the material can be removed.

No, it is not recommended to remove your own stitches. A healthcare professional should perform the removal to ensure the wound is properly healed and to prevent infection.

Mattress sutures, particularly the vertical mattress technique, are often used for wounds under high tension because they provide very strong closure and help to properly align the edges.