Introduction
In emergency and surgical settings, closure method selection directly impacts infection rates, healing time, and cosmetic outcomes. Research shows that inappropriate suture choice contributes to wound dehiscence, surgical site infections, and poor cosmetic results that affect patient satisfaction and quality of life.
Dozens of suture types are available—each with distinct absorption profiles, tensile strength characteristics, and tissue reactivity. The decision requires understanding material science, not just habit.
This clinical complexity has driven market innovation. The global surgical sutures market reached $4.787 billion in 2024 and is projected to hit $6.459 billion by 2030. Lacerations account for approximately 8.2% of Emergency Department visits in the U.S., resulting in an estimated 7 to 9 million repairs annually.
This guide examines traditional and emerging closure options, helping clinicians match materials to wound characteristics, patient factors, and desired outcomes—both functional and cosmetic.
TL;DR
- Absorbable sutures (Vicryl, Monocryl) best for deep layers; non-absorbables (nylon, polypropylene) for skin closure
- Monofilament sutures cut infection risk by 52% versus multifilament in contaminated wounds
- Suture size depends on location: 5-0 or 6-0 for facial repairs, 3-0 or 4-0 for trunk and extremities
- SubQ It! bioabsorbable closure: 7X faster than manual suturing with superior cosmetic outcomes
Overview of Sutures in Skin Laceration Repair
Selecting the right suture for skin laceration repair affects more than just wound closure. The decision directly impacts surgical outcomes, infection rates, cosmetic appearance, and patient comfort—while influencing healthcare costs through procedure time and follow-up requirements.
Clinical preferences are shifting toward technologies that improve outcomes while reducing costs. Absorbable sutures captured 53.24% of market share in 2025 and are projected to grow at a 7.56% CAGR through 2031, driven by value-based care models that eliminate removal visits.
Monofilament structures accounted for 58.46% of revenue in 2025, advancing at an 8.02% CAGR due to superior infection-control profiles compared to braided alternatives.
This guide categorizes the most commonly used suture materials for skin laceration repair:
- Absorbable vs. non-absorbable suture types
- Material-specific clinical applications
- Selection criteria based on wound characteristics
- Healing timeline considerations
Best Sutures for Skin Laceration Repair
Selecting the optimal suture requires balancing wound location, tension, healing timeline, and cosmetic expectations. No single material works for every scenario—success depends on matching suture properties to specific clinical needs.
Polyglactin 910 (Vicryl)
Vicryl is a synthetic braided absorbable suture manufactured by Ethicon. It's become the workhorse for subcutaneous layer closure across general surgery and dermatologic procedures, with a proven track record of predictable performance.
Key differentiators include:
- Maintains 75% tensile strength at 2 weeks and 50% at 3 weeks
- Complete absorption occurs by 56-70 days via hydrolysis
- Braided structure offers excellent handling with secure knot tying
- Minimal tissue reactivity compared to natural materials
- Coated versions reduce tissue drag during passage
| Attribute | Details |
|---|---|
| Absorption Profile | Complete absorption in 56-70 days via hydrolysis; maintains adequate strength throughout critical healing period |
| Best Applications | Subcutaneous closures, general soft tissue approximation, areas requiring support during initial healing phase |
| Key Advantages | Predictable absorption, good handling, secure knots, available in coated versions for reduced tissue drag |
| Tissue Reactivity | Minimal to moderate inflammatory response; suitable for most patients |
| Typical Sizes | 2-0 to 5-0 for dermatologic applications; 3-0 and 4-0 most common for subcutaneous facial repairs |
Poliglecaprone 25 (Monocryl)
Monocryl (Ethicon) is a synthetic monofilament absorbable suture favored for subcuticular skin closures. Its superior handling compared to other monofilaments makes it a top choice for facial repairs.
Monocryl maintains 50-60% strength at 1 week with minimal strength remaining by 3 weeks, absorbed by 91-119 days. The material offers exceptional pliability with minimal "memory," allowing smooth tissue passage that reduces trauma. Clinical studies show that Monocryl results in smaller, less reactive scars compared to Vicryl Rapide in subcuticular closure, making it ideal when cosmetic outcomes matter most.
| Attribute | Details |
|---|---|
| Absorption Profile | Complete absorption in 91-119 days; rapid initial strength loss limits use to low-tension applications |
| Best Applications | Subcuticular facial closures, pediatric repairs (eliminates traumatic removal), cosmetically sensitive areas |
| Key Advantages | Exceptional pliability, smooth tissue passage, minimal scarring, no suture removal required |
| Tissue Reactivity | Minimal inflammatory response; excellent for patients concerned about cosmetic outcomes |
| Typical Sizes | 4-0 to 6-0 for facial work; 5-0 most common for adult facial subcuticular closures |
Nylon (Ethilon, Dermalon)
For external (through-the-skin) closures, nylon monofilament sutures remain the gold standard. Available from Ethicon and Covidien, nylon offers reliability and cost-effectiveness across multiple specialties.
Providing long-term tensile strength with only 15-20% degradation per year, nylon maintains strength in contaminated or high-tension wounds. Minimal tissue reactivity reduces inflammation and scarring, while low cost makes it accessible. Nylon retains 72% of tensile strength immediately after implantation, though it may lose 30-50% by 2 years due to slow hydrolysis.
| Attribute | Details |
|---|---|
| Strength Retention | Permanent with gradual degradation of 15-20% annually; provides extended support for slow-healing wounds |
| Best Applications | External skin closures for face, scalp, extremities; microsurgery; any wound requiring removal after healing |
| Key Advantages | Excellent tensile strength, minimal tissue reaction, cost-effective, versatile across anatomic locations |
| Tissue Reactivity | Minimal inflammatory response; well-tolerated in most tissue types |
| Typical Sizes | 3-0 to 6-0 depending on location; 5-0 or 6-0 for facial repairs, 4-0 for trunk and extremities |
Polypropylene (Prolene)
Polypropylene (Prolene by Ethicon) stands out for running subcuticular closures due to its unique low-friction properties. Plastic surgeons commonly select it for facial repairs and vascular anastomoses.
Polypropylene provides permanent tensile strength with virtually no degradation over time. It demonstrates the lowest tissue reactivity of common sutures, remaining extremely inert. The very low coefficient of friction enables smooth passage through tissue for running sutures, while blue color provides excellent visibility. In randomized trials, polypropylene resulted in measurably better cosmetic outcomes (POSAS scores) compared to fast-absorbing gut (p < 0.001).
| Attribute | Details |
|---|---|
| Strength Retention | Permanent with virtually no degradation over time; ideal when long-term support essential |
| Best Applications | Running subcuticular closures, facial repairs (favored by plastic surgeons), vascular procedures |
| Key Advantages | Lowest tissue reactivity, smooth gliding for running sutures, excellent for pull-out technique, blue color provides visibility |
| Tissue Reactivity | Extremely minimal; ideal for patients with sensitivity concerns or inflammatory conditions |
| Typical Sizes | 3-0 to 6-0 for skin closures; 5-0 or 6-0 most common for facial subcuticular running sutures |
SubQ It! Bioabsorbable Skin Closure System
SubQ It! represents a modern alternative to traditional suturing.
This bioabsorbable subcuticular closure system combines the speed of stapling with superior cosmetic outcomes of subcuticular sutures.
This FDA-cleared disposable stapler comes pre-loaded with bioabsorbable dermal fasteners made from polylactic-co-glycolic acid (PLGA). The system performs closures 7X faster than manual suturing—deploying each fastener in just 7 seconds versus 42 seconds for traditional subcuticular stitches. The fasteners are absorbed by the body after healing, eliminating removal appointments. Because the external skin is never pierced, patients experience no "train track" scars. The system is particularly effective for laparoscopic and small incisions in abdominal, thoracic, gynecologic, orthopedic, and plastic surgery.
| Attribute | Details |
|---|---|
| Absorption Profile | Fasteners maintain 80% strength for 21 days before beginning absorption; complete absorption occurs after wound healing is established |
| Best Applications | Laparoscopic incisions, small surgical incisions in abdominal/thoracic/gynecologic/orthopedic/plastic surgery; ideal where speed and cosmesis both critical |
| Key Advantages | 7X faster than manual sutures, eliminates removal appointment and patient discomfort, no external scarring, subcuticular placement optimizes cosmetic results, ISO 13485 certified |
| Unique Technology | Bioabsorbable dermal fasteners inserted subcutaneously via pre-loaded disposable stapler; combines stapling speed with suturing cosmetics |
| System Options | Available in SU-10 (10 fasteners for incisions up to 10cm) and SU-25 (25 fasteners for incisions up to 25cm) models |
How to Choose the Right Suture for Skin Laceration Repair
Selecting the appropriate suture follows a systematic decision-making framework. Start by assessing wound characteristics: location, tension, contamination status, and patient factors.
Then match these to the appropriate suture material. Deep wounds need absorbable sutures for subcutaneous support, while surface closure can use absorbable subcuticular (no removal needed) or non-absorbable percutaneous (maximum strength, requires removal).
Key Selection Criteria
Wound Location and Cosmetic Importance:
- Face: 5-0 or 6-0 sutures with removal in 3-5 days
- Eyelids: 6-0 or 7-0 (removal at 3-5 days)
- Scalp: 4-0 or 5-0 material, remove after 7-10 days
- Trunk: 3-0 or 4-0 with 10-14 day removal
- Extremities: 4-0 or 5-0, removal timing 7-14 days based on location
Tension Level
High-tension wounds need stronger materials or deep support layers. Cosmetic tension-reducing suturing techniques significantly reduce scar width (1.98 mm vs. 4.55 mm at 12 months) and improve patient satisfaction (95% vs. 70%) compared to traditional methods.
Contamination Status
Monofilament sutures reduce surgical site infection risk (RR = 0.71) compared to multifilament options. Multifilament sutures carry a 2.3-fold higher infection-risk profile. In contaminated wounds, always choose monofilament materials.
Patient Factors
Pediatric patients benefit from absorbable options that eliminate traumatic removal. Compliance concerns may favor no-removal techniques like subcuticular absorbable sutures or bioabsorbable closure systems.
These selection criteria translate directly into clinical decision-making for specific wound types.
Practical Guidance for Common Scenarios
- Facial lacerations: Deep layer with 4-0 or 5-0 absorbable (Vicryl); surface with 6-0 non-absorbable (nylon) or subcuticular absorbable (Monocryl)
- Scalp wounds: 3-0 or 4-0 material with reverse cutting needle
- Extremity repairs under tension: Deep support with long-lasting absorbable like PDS; surface with 4-0 non-absorbable
- Contaminated wounds: Monofilament only; consider delayed closure
Technique and Closure Alternatives
Systematic reviews show that subcuticular continuous sutures yield significantly higher cosmetic scores (VAS) compared to interrupted sutures (OR = 0.27, p < 0.01) and demonstrate lower dehiscence rates (OR = 0.16, p < 0.01). The technique you choose often matters as much as the material.
For surgeons seeking faster closure times without compromising cosmetic outcomes, bioabsorbable subcuticular closure systems offer an alternative that combines speed with elimination of removal procedures—particularly valuable in minimally invasive and open surgical settings.
Conclusion
The optimal suture choice depends on balancing wound characteristics, healing timeline, cosmetic expectations, and patient-specific factors. Your goal: achieve secure closure, minimize complications, and optimize aesthetic outcomes.
Evidence shows that absorbable and nonabsorbable sutures produce no statistically significant difference in cosmetic outcomes, infection rates, or wound separation in facial closures.
Technique and appropriate sizing matter more than material category. Monofilament options reduce infection risk in contaminated wounds, while multifilament sutures offer superior handling for deep layers.
Stay current with evolving technologies. For surgical incisions requiring speed without compromising cosmetic outcomes, systems like SubQ It!'s bioabsorbable closure device deliver closures 7X faster than manual sutures while eliminating staple removal. Make evidence-based selections tailored to each unique clinical scenario rather than relying solely on habit or tradition.
Frequently Asked Questions
What is the best suture for skin closure?
The best suture depends on wound location and technique. Facial closures use 5-0 or 6-0 nylon with removal in 3-5 days. Subcuticular closures use Monocryl for superior cosmesis, while deep layers use Vicryl for strength and handling.
Is Monocryl better than Vicryl for skin closure?
Monocryl excels for subcuticular closures with smooth passage and minimal tissue reaction, ideal for cosmetically sensitive areas. Vicryl is better for deep layer closures where its braided structure provides superior handling and knot security.
How long does it take for absorbable sutures to absorb?
Fast-absorbing gut dissolves in 5-7 days. Vicryl and Monocryl absorb in 56-70 and 91-119 days respectively, while PDS takes 180-210 days. Tensile strength is lost well before complete absorption occurs.
Which suture is thicker, 3-0 or 4-0?
3-0 is thicker and stronger than 4-0. In the USP sizing system, smaller numbers mean larger diameter (3-0 > 4-0 > 5-0). Selection balances adequate strength against minimizing tissue trauma and scarring.
What are the five types of sutures?
The main categories are absorbable synthetic (Vicryl, Monocryl, PDS), absorbable natural (surgical gut), non-absorbable synthetic (nylon, polypropylene), non-absorbable natural (silk), and modern bioabsorbable closure systems.
What is the scarless suture method?
Subcuticular closure places sutures entirely below the skin surface, eliminating "railroad track" marks from percutaneous sutures. Typically performed with absorbable monofilaments like Monocryl or non-absorbable Prolene. This minimizes visible suture marks, though all wounds create some scarring.
