The Bottom Line
The suture technique your dermatologist uses to close a surgical wound has a major impact on your final scar appearance. Different techniques — from simple interrupted stitches to layered closures with buried sutures — are chosen based on wound location, tension, and cosmetic goals. Understanding suture techniques helps you appreciate why your surgeon makes specific choices and what to expect during recovery.
What Are Suture Techniques in Dermatologic Surgery?
Suture techniques are the methods dermatologic surgeons use to close wounds after skin excisions, Mohs surgery, biopsies, and other procedures. The choice of technique directly influences wound healing, scar width, scar elevation, and overall cosmetic outcome. Dermatologists are highly trained in selecting the optimal closure method for each wound based on its location, size, depth, tension, and the patient's skin type.
Modern dermatologic wound closure is typically "layered" — meaning multiple layers of sutures are placed at different depths in the skin. This distributes tension across the wound, reduces the load on surface stitches, and produces the narrowest possible scar.
Common Suture Techniques and When They're Used
Buried (deep) sutures — the hidden foundation:
Placed in the deep dermis using absorbable suture material (polyglactin/Vicryl or poliglecaprone/Monocryl). These are the most important sutures for final cosmetic outcome — they pull the deep wound edges together, eliminate dead space, and reduce tension on the skin surface. They dissolve on their own over 6-12 weeks. The buried vertical mattress suture is a workhorse technique that precisely everts (raises) wound edges, which is key for minimizing the final scar.
Simple interrupted sutures — the classic surface stitch:
Individual stitches placed across the wound surface, each tied separately. Advantages: if one stitch loosens or needs removal, the others continue holding. Used on the body, scalp, and anywhere wound tension is moderate. Typically removed in 5-14 days depending on location.
Running (continuous) suture:
A single continuous thread running along the wound like a spiral. Faster to place than interrupted sutures and distributes tension evenly. Often used for long, straight closures on the trunk or scalp.
Subcuticular (running intradermal) suture:
A continuous suture that runs within the dermis, parallel to the skin surface — no visible stitch marks on the skin. Produces the finest cosmetic result and is commonly used on the face. Can be absorbable (dissolves on its own) or non-absorbable (pulled out like a thread at 5-7 days).
Vertical mattress suture:
A suture that takes both a deep and superficial bite, powerfully everting wound edges. Used on the back, shoulders, and other areas with high tension where wound edges tend to invert (sink inward). Produces a stronger closure but may leave more visible stitch marks — often used temporarily and removed early.
Corner (half-buried mattress) suture:
A specialized technique for closing triangular flap tips — common after skin flap surgery. Maintains blood supply to the delicate flap tip while securing it in position.
Why Suture Technique Matters for Your Scar
The technique your surgeon chooses directly affects your scar quality:
- Wound edge eversion: Slightly raised (everted) wound edges produce the flattest final scar. Buried sutures and mattress techniques achieve this. Wound edges that sit flat or invert tend to create a depressed or widened scar.
- Tension distribution: Layered closure with buried sutures means the surface sutures bear minimal tension. Less surface tension = narrower scar and fewer suture track marks.
- Precise alignment: Meticulous surface suture placement ensures wound edges match exactly, preventing step-offs (where one edge is higher than the other).
- Timing of removal: Sutures left too long create permanent stitch marks ("railroad track" scars). Facial sutures are removed at 5-7 days, body sutures at 10-14 days.
Treatment: What to Expect with Sutures
During surgery: Your surgeon selects the closure technique before the procedure based on the wound's anticipated size, location, and tension. You won't feel the suturing — local anesthesia keeps the area numb throughout.
After surgery: Keep the wound covered and dry for 24-48 hours. After that, clean gently with water, apply petrolatum, and re-bandage daily. Do not pull or tug on sutures. Avoid stretching or straining the area.
Suture removal: Non-absorbable surface sutures are removed at your follow-up visit (5-7 days for face, 7-10 days for scalp, 10-14 days for body, 14-21 days for lower legs). Removal involves snipping the stitch and pulling it out — it's quick and usually painless.
After removal: Wound closure strips (Steri-Strips) are often applied for another 1-2 weeks to support the wound. Start silicone scar sheets or gel at 2-4 weeks to optimize scar appearance. The scar will be pink/red initially and gradually fades over 6-18 months.
When to See a Dermatologist
Contact your surgeon if a suture comes loose or pops out before your scheduled removal date, if the wound edges separate (dehiscence), if you notice signs of infection (increasing redness, pus, warmth, fever), or if you have concerns about how the wound is healing. After suture removal, see your dermatologist if the scar becomes raised, red, or thick (signs of hypertrophic scarring that may benefit from early treatment with silicone sheets or steroid injections).
Frequently Asked Questions
Why does my surgeon use absorbable sutures underneath and non-absorbable on top?
Absorbable (dissolving) sutures are placed deep in the tissue where they can't be removed — they do their job of holding the wound edges together for weeks while gradually dissolving. Non-absorbable sutures on the surface can be precisely removed at the optimal time (before they leave permanent stitch marks), which gives the best cosmetic result. This layered approach combines the strength of deep closure with the precision of surface closure.
Will I have visible stitch marks?
With modern layered closure techniques and timely suture removal, visible stitch marks ("railroad tracks") are uncommon. The key factors are: surface sutures should bear minimal tension (buried sutures do the heavy lifting), and surface sutures should be removed at the appropriate time for the body area. Subcuticular (hidden) sutures leave no surface marks at all, which is why they're preferred for facial closures.
Does it hurt to have sutures removed?
Suture removal is usually painless or causes only minor discomfort — a brief tugging sensation as each stitch is pulled through. No anesthesia is needed. The process takes 2-5 minutes for most wounds. If you're anxious, let your provider know — they can apply topical numbing cream beforehand.
What happens if a suture falls out early?
If a surface suture comes out early, don't panic. If the wound is held together by buried (deep) sutures, the loss of one surface stitch is usually not a problem. Apply wound closure strips (Steri-Strips) across the area and contact your surgeon's office. If the wound edges are gaping, seek same-day evaluation for possible re-suturing.
References
- Kantor J. Atlas of Suturing Techniques: Approaches to Surgical Wound, Laceration, and Cosmetic Repair. McGraw-Hill. 2016.
- Zitelli JA, Moy RL, Abell E. Buried vertical mattress suture. J Dermatol Surg Oncol. 1989;15(1):17-19.
- Adams B, Anwar J, Wrone DA, Alam M. Techniques for cutaneous sutured closures: variants and indications. Semin Cutan Med Surg. 2003;22(4):306-316.
- Yag-Howard C. Sutures, needles, and tissue adhesives. Dermatol Surg. 2014;40(S9):S3-S15.
Trusted Resources
- American Academy of Dermatology Association. "Dermatologic Surgery." aad.org
- American College of Mohs Surgery. mohscollege.org
- American Society for Dermatologic Surgery. asds.net
Trust your dermatologic surgeon's suture technique selection — they choose the method that will give your specific wound the best possible cosmetic and functional outcome.