Selection of surgical suture should be determined by the characteristics and location of the wound or the specific body tissues being approximated.

[1] In selecting the needle, thread, and suturing technique to use for a specific patient, a medical care provider must consider the tensile strength of the specific suture thread needed to efficiently hold the tissues together depending on the mechanical and shear forces acting on the wound as well as the thickness of the tissue being approximated.

[1] Absorbable sutures are either degraded via proteolysis or hydrolysis and should not be utilized on body tissue that would require greater than two months of tensile strength.

It is generally used internally during surgery or to avoid further procedures for individuals with low likelihood of returning for suture removal.

[2] To-date, the available data indicates that the objective short-term wound outcomes are equivalent for absorbable and non-absorbable sutures, and there is equipoise amongst surgeons.

In general synthetic materials will keep tensile strength for longer due to less local tissue inflammation.

[2] These sutures hold greater tensile strength for longer periods of time and are not subject to degradation.

[6] Silk (polyfilament, Permahand, Ethicon; Sofsilk, Covidien) Synthetic materials include nylon, polypropylene and surgical steel all of which are monofilaments with great tensile strength.

[2] Nylon (monofilaments, Dermalon, Ethilon) Nylon (polyfilaments, Nurolon, Surgilon, Supramid) Braided polyester (polyfilament, Ethibond, Dagrofil, Synthofil, PremiCron, Synthofil) Polybutester (monofilament, Novafil) Surgical steel Suture sizes are defined by the United States Pharmacopeia (U.S.P.).

The vertical and horizontal mattress stitch are also interrupted but are more complex and specialized for everting the skin and distributing tension.

Ideally, sutures bring together the wound edges, without causing indenting or blanching of the skin,[17] since the blood supply may be impeded and thus increase infection and scarring.

[18] Placement varies based on the location, Skin and other soft tissue can lengthen significantly under strain.

For example, Cesarean section can be performed with single or double layer suturing of the uterine incision.

[24] Topical cyanoacrylate adhesives (closely related to super glue), have been used in combination with, or as an alternative to, sutures in wound closure.

The adhesive remains liquid until exposed to water or water-containing substances/tissue, after which it cures (polymerizes) and forms a bond to the underlying surface.

Limitations of tissue adhesives include contraindications to use near the eyes and a mild learning curve on correct usage.

Skin glues like Indermil and Histoacryl were the first medical grade tissue adhesives to be used, and these are composed of n-butyl cyanoacrylate.

The longer side chain types, for example octyl and butyl forms, also reduce tissue reaction.

[26] The Greek father of medicine, Hippocrates, described suture techniques, as did the later Roman Aulus Cornelius Celsus.

[28][29] The gut suture was similar to that of strings for violins, guitars, and tennis racquets and it involved harvesting sheep or cow intestines.

In fact, gut sutures have been banned in Europe and Japan owing to concerns regarding bovine spongiform encephalopathy.