Classification

Category	General behaviour	Tissue reactivity	Typical role
Absorbable monofilament	Loses strength over time; lower drag through tissue	Low	Buried dermal / subcuticular support where a removable skin stitch is not desired
Absorbable braided	Handles and knots well; braided structure can increase tissue drag	Moderate	Selected mucosal or buried closure where local practice favours it
Non-absorbable monofilament	Retains tensile strength until removed; low tissue drag	Low	Skin-edge apposition where planned removal is appropriate
Braided / natural non-absorbable material	Easy handling but greater capillarity and tissue reaction	Higher	Reserved for selected indications according to surgeon preference and local practice

Closure choice by anatomy

Site	Closure priorities	Practical considerations
Face, eyelid, lip, nose	Precise anatomical alignment, minimal track marks, early scar quality	Avoid tension on the skin edge; align free margins and aesthetic borders meticulously.
Scalp	Haemostasis, robust deep support, ease of aftercare through hair	Layered support and secure dressing are often more important than the exact skin-closure material.
Trunk / abdomen	Tension management and scar widening prevention	Deep support and alignment with relaxed skin tension lines matter most.
Lower limb	Tension reduction, oedema control and wound-healing risk	Consider staged closure, grafting, compression planning or delayed healing where perfusion is poor.
Hand / foot	Function, tendon glide, splinting and avoidance of joint contracture	Immobilisation and hand-therapy planning may be more important than the closure material.
Mucosal / anogenital	Comfort, moisture, contamination and low foreign-body reaction	Use local specialist practice and patient comfort to guide closure choice.

Tension placed on the deep supportive layer; the skin edge should appose, not strangulate.
Buried interrupted dermal: knot inverted to lie deep.
Subcuticular continuous: cosmetically useful in selected low-tension wounds; removal or absorption depends on material and local practice.
Vertical mattress: good wound eversion; reduces step-off; useful on lower legs, dorsal hand.
Horizontal mattress: useful for high-tension closure (anterior tibia, scalp).
Half-buried horizontal mattress (tip stitch): for flap tips and corner closure where vascularity must be protected.
Avoid high-reactivity or capillary materials where infection risk, chronic foreign-body reaction or delayed healing matters.

Track-mark appearance is minimised by avoiding tension on the skin edge and using timely review / removal where removable skin closure is used.
For Mohs reconstruction and staged grafting, closure and fixation should be selected according to defect contour, graft stability and local unit practice.
Counsel patient about scar massage from week 2-3; silicone gel from week 4 for 3 months in keloid-prone patients.
Document closure method, aftercare and review / removal plan in the operation note.
In poor wound-healing sites, prioritise tension reduction, perfusion, oedema control and infection prevention.
Tissue adhesives can be useful for selected low-tension closures.