When to use each type of suture technique?

September 26, 2025 •

4 min read

According to research from the National Center for Biotechnology Information (NCBI), the appropriate selection of sutures and techniques can significantly reduce wound complications and improve cosmetic outcomes. Choosing wisely is therefore paramount for anyone in healthcare, making a clear understanding of when to use each type of suture technique a foundational skill.

Quick Summary

Different clinical scenarios dictate the choice of suture technique, which depends on factors like tissue type, tension, infection risk, and cosmetic outcomes. This involves selecting appropriate absorbable or non-absorbable materials, considering monofilament versus multifilament properties, and using techniques like simple interrupted, mattress, or subcuticular stitches tailored to the specific wound location and depth.

Key Points

Absorbable vs. Non-Absorbable: Choose absorbable sutures for internal layers or where removal is difficult; use non-absorbable for strong, long-term support or surface skin that will be removed.
Monofilament vs. Multifilament: Opt for monofilament sutures in high-infection-risk areas due to lower bacterial potential, while multifilament provides stronger knots for less-sensitive tissues.
Technique for High Tension: The vertical or horizontal mattress techniques are superior for closing wounds under high tension and preventing edge inversion.
Best for Aesthetics: The continuous subcuticular technique is ideal for cosmetically sensitive areas, as it leaves no external suture marks.
Prioritize Wound Characteristics: Selection of both suture material and technique must be based on tissue type, wound location, and the amount of tension to ensure optimal healing and cosmetic results.

Understanding the Fundamentals of Suture Selection

Before delving into specific techniques, it's crucial to understand the characteristics of the sutures themselves, as the material dictates the method. Sutures are categorized based on several properties: absorbability, filament type, and material origin (natural vs. synthetic).

Absorbable vs. Non-Absorbable Sutures

Absorbable Sutures: These are designed to break down naturally in the body over time. They are ideal for internal wounds or for skin closures where a patient might not return for suture removal. The rate of absorption varies, influencing their use in different tissue types. Fast-absorbing sutures are suited for wounds with minimal tension, while slow-absorbing ones are used for tissues requiring longer support, like fascia.
Non-Absorbable Sutures: These sutures are permanent and must be manually removed or left in place indefinitely for long-term tissue support. They are typically used for skin closure in cosmetically sensitive areas, tendon repairs, or for securing medical devices. Examples include nylon and polypropylene.

Monofilament vs. Multifilament Sutures

Monofilament Sutures: Consist of a single strand. Their smooth surface causes minimal tissue trauma and makes them less prone to harboring bacteria, making them the choice for wounds with a high risk of infection. However, they can be more difficult to handle and have a tendency to be stiff.
Multifilament Sutures: Composed of multiple braided or twisted strands. They offer superior knot security and tensile strength but can be more susceptible to infection and cause more friction when passed through tissue. They are not typically recommended for contaminated wounds.

Essential Suture Techniques and Their Applications

Proper technique is as vital as the right suture material. Here is a breakdown of common methods and when they are best applied.

Simple Interrupted Suture

This is the most fundamental and widely used technique. Each stitch is placed and tied individually. This technique is excellent for wounds with minimal tension and provides strong, reliable closure. It prevents the entire wound from dehiscing (re-opening) if one stitch fails, unlike a continuous suture.

When to use: General skin closure, internal organ repair, and layered closures. It's particularly useful for approximating wound edges with precision.

Vertical Mattress Suture

This technique involves both far-far and near-near passes of the needle. This provides superior wound edge eversion, which is crucial for preventing a depressed scar. It is also excellent for closing poorly supported or mobile skin.

When to use: Skin closure on the extremities, back, or any area where wound edges tend to invert. It's also suitable for providing extra tension relief.

Horizontal Mattress Suture

This stitch runs parallel to the wound edges and is great for distributing tension evenly across a wound. It's particularly effective for closures in areas under high tension.

When to use: Wounds on the palm or sole, and for closures where tension needs to be distributed over a wider area. It's also used to secure grafts.

Continuous Subcuticular Suture

This cosmetic stitch is placed horizontally within the dermal layer, avoiding entry and exit through the skin's surface. It provides excellent skin edge approximation and leaves no visible track marks, making it ideal for aesthetics.

When to use: Clean wounds in cosmetically sensitive areas, such as the face or neck. It is best used for low-tension wounds where deep dermal sutures have already provided primary tension relief.

Running or Simple Continuous Suture

Unlike the interrupted technique, this involves a single, continuous strand of suture material. It is faster to place and provides a water-tight seal, but if the strand breaks, the entire wound can open. This technique is more commonly used for internal closures.

When to use: Closing blood vessels or fascia, or for intestinal surgery where a leak-proof closure is needed.

Comparison of Suture Techniques


Technique	Primary Use	Tension Handling	Cosmetic Outcome	Time to Perform
Simple Interrupted	General skin closure, internal layers	Moderate	Good	Slowest
Vertical Mattress	Wounds with eversion issues (e.g., loose skin)	Excellent	Excellent	Medium
Horizontal Mattress	Wounds under high tension (e.g., palms)	Excellent	Good	Medium
Continuous Subcuticular	Clean wounds, cosmetically sensitive areas	Low to moderate	Excellent	Medium
Running Continuous	Fast closure of long, linear incisions	Low to moderate	Fair	Fastest

Considerations for Optimal Wound Closure

Beyond technique, several factors influence the choice of suture and procedure. Proper tissue handling is paramount to minimize trauma and promote healing. Infection risk is another major consideration; monofilament sutures are often preferred in higher-risk situations. The location and thickness of the tissue are also key, as taper needles are used for delicate internal tissues while cutting needles are necessary for tough skin. The best results come from a combination of the right materials and the right technique, applied with careful precision based on the wound's specific characteristics.

Combining Techniques for Best Results

In many complex wounds, a combination of techniques may be necessary. For instance, deep dermal layers may require buried interrupted absorbable sutures to take the bulk of the tension off the wound edges. The skin itself can then be approximated with a continuous subcuticular stitch for an optimal cosmetic finish. This layered approach addresses both the underlying structural integrity and the final aesthetic outcome.

Conclusion: Mastering the Art of Wound Closure

Mastering the art of wound closure involves more than just mechanical skill; it requires a deep understanding of tissue properties, material science, and the specific demands of each clinical scenario. From the strong, reliable closure of a simple interrupted suture to the superior cosmetic finish of a subcuticular technique, each method has its place. By carefully considering the wound characteristics and patient factors, medical professionals can make informed decisions that lead to faster healing, fewer complications, and the best possible outcomes for their patients. Continuous learning and a nuanced approach to selecting the right tools and methods are what truly set experts apart.

Visit the American College of Surgeons for more information on surgical skills and patient care standards.

Frequently Asked Questions

An interrupted technique involves tying off each stitch individually, providing greater security against a single failure. A continuous technique uses a single, running strand of suture, which is faster to place but risks the entire wound opening if the suture breaks.

Use a vertical mattress suture for wounds under high tension or in areas where the skin edges tend to invert. Its unique far-far, near-near pattern ensures proper edge eversion and helps prevent 'dead space' beneath the skin.

Neither is inherently 'better'; their suitability depends entirely on the clinical application. Absorbable sutures are preferred for internal use, while non-absorbable are necessary for long-term strength or external skin closure requiring removal.

The primary advantage of a monofilament suture is its smooth surface, which causes less tissue trauma and is less likely to harbor bacteria. This makes it a better choice for contaminated wounds or areas with a high risk of infection.

For facial wounds, which are highly cosmetically sensitive, a continuous subcuticular suture with a fine monofilament, absorbable material is often the preferred technique. This minimizes visible skin marks and provides excellent aesthetic results.

Yes, suture choice can influence infection risk. Multifilament sutures have a greater capillary action that can wick bacteria into the wound, increasing the risk of infection compared to monofilament sutures. The type of material and patient factors also play a role.

Yes, it is common to combine different techniques on a single wound. For example, a surgeon might use buried absorbable interrupted sutures to close deep tissue layers, followed by a continuous non-absorbable subcuticular suture for the skin to manage tension and optimize cosmetic outcome.