Surgical Sutures: Types, Techniques & Their Role in Modern Procedures

Surgical sutures are one of the most important tools in modern medicine. They play a vital role in wound closure, healing, and recovery after an operation or injury. From simple cuts to complex surgeries, sutures help tissues come together so the body can heal naturally. Without them, even a small wound could take much longer to heal and may carry a higher risk of infection.

A surgical suture is a special thread used by surgeons to close wounds or surgical incisions. Think of it as a "stitch" that holds the skin, muscles, or internal tissues together. [Daphne Di1] ^[1] These sutures are designed to either stay in your body permanently or dissolve naturally over time. The choice of type and size depends on the type of surgery, the location of the wound, and the expected rate of recovery.

Suture Size

Suture size refers to the thickness of the thread, which affects how it handles and supports a wound. The numbering system works in reverse, meaning a higher number indicates a finer suture; for example, a 7-0 suture is thinner than a 4-0. Surgeons typically select the smallest size that allows for safe healing.

Sutures are generally divided into different categories based on their properties. Types of surgical sutures:

• Absorbable vs Non-absorbable

• Monofilament (single thread) vs Multifilament (braided)

• Natural vs Synthetic materials^[2]

The type is selected for a specific type of surgery. For example, braided sutures may be easier to tie, while monofilament ones may reduce infection risk.

Absorbable sutures are designed to dissolve inside the body once the tissue has healed. They are often used in:

• Internal tissues such as the stomach or bladder

• Situations where stitch removal would be difficult

• Patients who may not return for follow-up visits

Benefits include:

• No need for removal

• Lower risk of leaving foreign material in the body

• Useful in surgeries where healing happens fairly quickly

Absorbable sutures are grouped based on the material from which they are made.

• Natural absorbable sutures include Plain Catgut, which dissolves quickly and is used for soft tissues, and Chromic Catgut, which lasts slightly longer and offers better wound support.

• Synthetic absorbable sutures include Polyglycolic Acid (PGA) and Polyglactin 910, both known for reliable strength and absorption. Polyglactin 910 Rapid is used when short-term support is needed. Poliglecaprone 25 and Polydioxanone (PDO) provide smoother handling and longer-lasting support.

Non-absorbable sutures do not dissolve in the body. They are either removed by a healthcare professional once healing has taken place, or they remain permanently in certain types of surgery.

Common uses include:

• Skin closure after operations

• Cardiovascular surgery where permanent support is required

• Orthopaedic procedures

• Long-term tissue support

The types of non-absorbable sutures too can be grouped based on the material they are made from:

• Silk sutures: They are easy to handle, often used in general surgery

• Nylon sutures: They are strong and resistant to breaking

• Polyester sutures: They have good strength and durability

• Polypropylene sutures: They have a low risk of infection, and are widely used in heart and eye surgeries

The way a suture is applied is just as important as the material used. Surgeons use different techniques depending on the type of wound.

Some widely used patterns include:

Sutures have come a long way from being made of simple natural fibres. Today, innovation has led to:

• Synthetic absorbable sutures that dissolve at predictable rates

• Antibacterial-coated sutures that help reduce the risk of Surgical Site Infections (SSIs).

• Coloured sutures for better visibility during surgery

• Biodegradable materials that improve healing outcomes

These advancements mean fewer complications, quicker healing, and improved patient comfort.

Choosing the right suture is a careful decision. Surgeons consider:

• Tissue type: skin, muscles, internal organs

• Expected healing time: fast-healing vs slow-healing areas

• Infection risk: certain materials reduce bacteria build-up

• Cosmetic outcome: whether visible scarring should be minimised

• Patient factors: age, health conditions, lifestyle

While sutures have been used to close a wound, there are alternatives:

The future of advances in surgical sutures looks promising with:

• Smart sutures that change colour to detect healing and detect infection.

• Bioengineered sutures that release medicines directly into the wound.^[3]

• Robotic-assisted suturing for precise closure in minimally invasive surgeries.

These innovations aim to make surgery safer, faster, and less painful for patients.

Surgical sutures are much more than just "stitches." They are a cornerstone of modern medicine, making surgeries safer and recoveries faster. With continuous innovations, sutures today are designed for better strength, reduced infection, and improved cosmetic outcomes. As medical science advances, sutures will continue to ensure better healing and patient care.