Wound closure is the final and in some respects most consequential step of any surgical procedure — determining the trajectory of healing, infection risk, cosmetic outcome, and patient experience over the weeks following surgery. The evidence base for wound closure technique selection has expanded substantially over the past decade, with systematic reviews and large RCTs now informing evidence-based choices across material type, closure layer, and adjunctive technology. The choice is not trivial: a 2017 JAMA Surgery meta-analysis found suture closure of skin reduced SSI by 39% compared to staples for colorectal procedures — a difference with direct patient safety implications.
Sutures: Material Selection
Suture selection involves wound type, healing time, infection risk, and closure layer considerations: Absorbable monofilament (Monocryl/poliglecaprone, Vicryl Plus/polyglactin with triclosan): Preferred for subcuticular skin closure — monofilament reduces bacterial adherence 10× compared to braided suture; triclosan coating provides antimicrobial activity. Cochrane meta-analysis (2014): triclosan-coated sutures reduce SSI by 27% versus uncoated sutures (11 RCTs, 3,990 patients) — the strongest suture-related SSI prevention evidence available. Absorbable braided (Vicryl, Dexon): Preferred for deep fascial closure and GI anastomoses — superior knot security and handling. Higher bacterial adhesion limits use in infected fields. Non-absorbable monofilament (nylon, polypropylene): For skin closure requiring removal (7–14 days), cardiovascular surgery (polypropylene has lowest tissue drag of any suture), and tendon repair. Barbed sutures (V-Loc, Quill): Self-anchoring bidirectional barbs eliminate need for knots — meta-analyses show equivalent outcomes to conventional sutures in TKA/THA closure with 20–30% faster closure time.
Staples vs. Sutures for Skin Closure
A landmark 2014 BMJ meta-analysis (11 RCTs, 682 patients) found metal staples associated with 3× higher SSI rate versus subcuticular sutures for orthopedic procedures. The IRIDIS trial (2015, NEJM, n=1,200) confirmed staple-associated SSI increase for hip/knee arthroplasty. For abdominal closure, a 2017 JAMA Surgery meta-analysis (n=3,112) found suture closure associated with 38% SSI reduction versus staples. The Cochrane Collaboration 2014 review across all surgical types found no SSI advantage for staples in any procedure type. These findings have driven adoption of subcuticular absorbable suture as the preferred skin closure for most procedures at infection-prevention-focused surgical centers.
Tissue Adhesives and Steri-Strip Alternatives
2-octyl cyanoacrylate (Dermabond, Prineo) applied over subcuticular suture or as primary closure for simple lacerations and short surgical incisions — provides a waterproof bacterial barrier, reduces dressing burden, and shows equivalent cosmetic and wound healing outcomes for incisions <10cm. Prineo mesh-adhesive combination demonstrates non-inferiority to staples for hip/knee arthroplasty closure in multiple RCTs with lower patient-reported pain. Our wound care catalog includes comprehensive suture, staple, tissue adhesive, and dressing options for optimized surgical wound management, along with sterile surgical gloves for clean technique maintenance throughout closure.
