What type of suture is recommended for skin closure?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: March 16, 2026 • View editorial policy

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question

Recommended Suture Type for Skin Closure

For skin closure, use an absorbable continuous subcuticular suture, specifically 4-0 poliglecaprone or 4-0 polyglactin, as this technique significantly reduces superficial wound dehiscence compared to interrupted sutures while maintaining equivalent rates of surgical site infection. 1

Evidence-Based Rationale

Primary Recommendation: Absorbable Continuous Suture

The World Journal of Emergency Surgery guidelines (2020) provide strong evidence (Grade 1B) supporting absorbable continuous subcuticular sutures as the preferred method for skin closure 1:

  • Wound dehiscence reduction: Continuous subcuticular sutures demonstrate an 8-fold reduction in superficial wound dehiscence (RR 0.08; 95% CI 0.02 to 0.35) compared to interrupted non-absorbable transcutaneous sutures 1

  • Equivalent infection rates: No statistically significant difference exists in superficial surgical site infection rates between continuous and interrupted techniques (RR 0.73; 95% CI 0.40 to 1.33) 1

  • Hospital stay: Length of hospital stay is comparable between both methods 1

Specific Suture Materials

The evidence specifically supports these absorbable materials for continuous subcuticular closure 1:

  • 4-0 poliglecaprone (Monocryl): Retains 50-75% of original tensile strength after 1 week in situ 1
  • 4-0 polyglactin (Vicryl): Similar tensile strength retention profile 1

This extended tensile strength support beyond the first week is the mechanistic reason for reduced dehiscence rates compared to interrupted non-absorbable sutures that are typically removed at 7-9 days 1

Additional Supporting Evidence

Recent meta-analysis (2023) confirms superiority of continuous sutures over interrupted sutures 2:

  • Higher visual analogue scale (VAS) scores for cosmetic appearance among both patients and physicians (OR = 0.27,95% CI = 0.07-0.47, P < .01) 2
  • Significantly lower dehiscence incidence (OR = 0.16,95% CI = 0.07-0.37, P < .01) 2

A randomized controlled trial in cesarean delivery (2017) demonstrated that poliglecaprone 25 reduced overall wound complications to 8.8% compared to 14.4% with polyglactin 910 (RR 0.61,95% CI 0.37-0.99; P=.04) 3

Why Not the Other Options?

Non-Absorbable Continuous Suture

While technically feasible, non-absorbable continuous sutures require removal, increasing patient discomfort and healthcare visits without demonstrable benefit over absorbable alternatives 4

Absorbable or Non-Absorbable Vertical/Horizontal Mattress Sutures

Mattress sutures (vertical or horizontal) are interrupted techniques that:

  • Show higher dehiscence rates compared to continuous subcuticular methods 1
  • Leave visible suture marks when placed transcutaneously 1
  • Are not supported by guideline-level evidence for routine skin closure 1

Non-Absorbable Standing Sutures

This term typically refers to interrupted transcutaneous sutures, which the evidence demonstrates are inferior to continuous subcuticular techniques for wound dehiscence outcomes 1

Important Clinical Considerations

Technique matters: The continuous suture must be placed subcuticularly (below the epidermis) rather than transcutaneously to achieve optimal cosmetic results and reduced dehiscence 1

Avoid over-tightening: Continuous sutures pulled too tightly can strangulate wound edges, negating their benefits 1

No benefit from adjuncts: Adding adhesive steri-strips to subcuticular sutures does not improve outcomes and is not recommended 1

Evidence quality caveat: While the recommendation is strong (Grade 1B), the underlying evidence comes primarily from studies in pediatric/adolescent appendectomy patients, indicating some uncertainty when extrapolating to all surgical populations 1

References

Related Questions

What suture material and technique should be used for a superficial skin laceration ≤5 cm, and how long should the sutures remain in place?
What is the recommended assessment and treatment plan for managing gluteal region issues (e.g., injections, injuries, infections) in the emergency department?
Should a 13-year-old patient requesting breast augmentation undergo the procedure, and what is the appropriate management if it should not be performed?
What is the appropriate management for a 21-year-old male presenting with dysuria and urinary frequency one day after unprotected intercourse?
How should a 73-year-old woman with a one‑week history of cough be evaluated and managed?
Can sertraline cause bone pain?
Can I give 50 mg of Thorazine (chlorpromazine) orally as a PRN dose for agitation?
Can methylphenidate cause irritability?
Can donepezil cause urinary retention?
What is the most likely cause of a lacy‑appearing rash?
What is a 4.2 cm ectatic ascending aorta?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.