Wound Closure and Suturing Guide with
B. Braun
Publish date: 01 November 2026
Summary
Sutures are a key component of wound closure in primary care.
They provide high mechanical strength with precise tissue edge approximation for acute lacerations and minor surgical procedures. Sutures are mostly used for primary intention healing.
Closing a wound correctly supports infection prevention and can reduce scarring.
Sutures come in a wide range of options to suit the type and location of wounds clinicians face.
WMS stocks B. Braun sutures, including absorbable and non-absorbable, monofilament and braided construction, and a range of sizes, needles, and thread lengths in Monosyn®, Novosyn®, Novosyn® Quick and Dafilon® options.
On this page, we look at how wounds heal, how to choose between suture types, and how size and needle shape affect closure.
Wound Closure and Suturing
When closing a wound, you are creating a temporary and calculated environment that helps the body to heal and reconstruct itself, by rebuilding the tissue between the skin edges.
Wound care terminology:
• Suture = the physical medical thread.
• Stitch = a single loop of suture placed in the tissue.
One of the first decisions a clinician needs to make is whether a wound needs suturing in the first place.
The skin is not one uniform sheet. To know whether a suture is suitable you first need to evaluate the anatomy of the wound.
There are three main layers of skin interacting with each other:
• Epidermis: The superficial outer barrier
• Dermis: The structural middle layer
• Hypodermis: The deep fatty layer
Epidermis
The epidermis has no blood vessels and regenerates on its own, so superficial grazes heal without a scar.
But if you cut yourself and see blood, you have breached the dermis layer of skin.
This layer contains nerve endings, sweat glands and collagen bundles that give your skin its structural strength.
Dermis
When the dermis is damaged, it does not regenerate in the same way the epidermis does.
It heals through a process called granulation.
Granulation tissue is new tissue made of collagen and blood vessels that bridges the wound.
Hypodermis
While the dermis forms granulation tissue, the hypodermis heals using its own subcutaneous fat cells and deep fascial fibroblasts.
When a deep injury occurs, these cells multiply and trigger new blood vessel growth, while specialised cells called myofibroblasts pull the base of the wound together.
Instead of making a loose fatty seal, the hypodermis builds a strong matrix woven with collagen. It also releases vital chemical signals that guide and support the healing of the skin layers above it.
Because of these skin layers, clinicians need to adapt to the physical properties of the tissue they are dealing with.
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Methods of Wound Closure
Wounds are classed by how they heal, known as healing intentions. The class of wound determines whether and when you should close a wound.
Healing intentions consist of the following:
Primary Intention Wound Closure
Healing by primary intention is the standard process for clean, sharp wounds where the edges can be easily brought together.
The general rule with primary intention is that it needs to happen within 12 hours of the injury, or up to 24 hours for clean facial wounds.
Closing a wound after this window raises the risk of trapping bacteria inside.
Secondary Intention Wound Closure
With later wounds, clinicians pivot to secondary intention.
Secondary intention purposely leaves the wound open to heal from the base upwards.
This is also the go-to option for injuries like scrapes, torn away tissue and deep abscesses.
Secondary intention heals slower. The wound fills slowly from the base with granulation tissue.
This process takes longer to heal, often taking weeks, and leaves a more noticeable scar.
The benefit to secondary intention is that it lets inflammatory fluids and bacteria drain out rather than collect under the skin.
Tertiary Wound Closure
Considered the middle ground approach when it comes to wound closure healing.
This approach is usually chosen for wounds like animal bites or lacerations that occurred in unsanitary conditions.
Closing these wounds straight away can trap bacteria and raises the risk of infection.
With tertiary intention, the procedure is to thoroughly clean the wound, wrap it, then leave it open for 3-5 days.
This process gives the immune system access to flush out bacteria in the area.
Once the environment is clean and shows no sign of infection, clinicians can then stitch the wound closed.
Pretibial Lacerations
Pretibial lacerations need a different approach compared to the previous three.
Pretibial lacerations and shin skin injuries are tricky to deal with, particularly in older adults.
This is because the skin is stretched tight over the bone and thins with age. This area of the body is generally not recommended for suturing according to NHS Scotland.
Sutures placed in the shin area can tear through the skin when the tension builds.
Instead, it is advised to irrigate with saline, carefully un-roll the bruised skin flap, and use adhesive closure strips to gently hold the skin in place.
Suture Choice
Once it is determined that a wound is safe to close, the next decision is what is the most suitable suture to use.
Using the wrong material can delay patient healing and worsen scarring.
The first-choice clinicians need to make is between absorbable and non-absorbable suture material.
Absorbable Sutures
Most absorbable sutures, like Novosyn, are synthetic polymers such as polyglactin 910 and glyconate.
The time the body takes to absorb these sutures depends on the material. Typical timeframes run from about 21 to 90 days.
The B. Braun Novosyn range of sutures absorbs within around 56 to 70 days.
Novosyn Quick in around 42 days.
For the Monosyn suture range it is around 60 to 90 days.
The body breaks down absorbable sutures depending on their composition:
• Natural materials: like surgical gut, are digested by specialised enzymes.
• Synthetic materials: break down through hydrolysis, where water in bodily fluids splits the polymer chains into microscopic fragments.
Specialised immune cells called macrophages then gather around the site to clear away the broken-down material and debris.
Sutures like B. Braun Monosyn and Novosyn Quick are often used for internal tissue layers and subcuticular closures.
This means patients do not need a follow-up appointment to have their stitches removed.
Non-Absorbable Sutures
So why use a thread that needs a follow-up when absorbable sutures exist?
Non-absorbable suture material keeps its strength for longer and causes little tissue reaction, which supports skin that needs time to heal.
Absorbable sutures can close skin, but non-absorbable material is commonly used for interrupted skin sutures.
Non-absorbable sutures are usually made from nylon (polyamide), polypropylene, or silk.
Nylon and polypropylene cause less tissue reaction than silk. Nylon loses strength gradually over long periods.
Nylon and polypropylene cause minimal reaction, so the skin can heal normally around the suture.
As a rule of thumb:
• Non-absorbable sutures: commonly used to close the skin surface (Epidermis)
• Absorbable sutures: commonly used for deeper layers of the skin (Dermis and Hypodermis)
The Dafilon range of B. Braun sutures are a non-absorbable polyamide monofilament option for soft tissue approximation and ligation where long-term wound support is needed.
| Feature | Absorbable | Non-absorbable |
|---|---|---|
| How it breaks down | Hydrolysis or enzymes, over weeks | Polyamide loses strength gradually over a long period |
| Typical materials | Polyglactin 910, glyconate | Polyamide (nylon), polypropylene, silk |
| Wound support | For a defined period. Novosyn® keeps 40 to 50% of its tensile strength at 21 days | Longer-term support |
| Time to absorb | Varies by material, from about 6 weeks to 90 days in the four launch families | Not absorbed |
| Removal | Usually not required | May require removal, depending on use |
| Typical uses | Deeper layers, intracutaneous and subcutaneous closure, paediatric surgery | Skin closure, soft tissue approximation, ligation |
| B. Braun range | Monosyn®, Novosyn®, Novosyn® Quick | Dafilon® |
Suture Construction
Once you have decided on an absorbable or non-absorbable suture, you next need to consider suture construction.
Sutures come in two types:
• Monofilament
• Braided
Monofilament Sutures
Monofilament sutures are a smooth, single thread. Think of something like a fishing line.
Because they are smooth, monofilament sutures glide easily through the tissue with minimal abrasion and are less likely to cause friction trauma.
The smooth surface of monofilament sutures also has fewer spots for bacteria to hide, making them safer for contaminated wounds seen in traumatic injuries.
But the smooth nature of monofilament is also its biggest drawback.
Monofilament sutures have what is called a "memory", meaning they want to return to their original shape.
When you tie a knot in it, the thread wants to unbend, so the knot is at risk of becoming undone.
This is a common frustration, and clinicians often need to tie multiple knots in the thread to make sure the suture stays in place.
Braided Sutures
Braided sutures on the other hand, behave differently. They are made of multiple fibres woven together, a bit like a rope.
Braided sutures are suppler and easier to bend, and the extra friction from the woven strands means they hold a knot much more securely.
The drawback of braided sutures is capillarity, where fluid is drawn along the thread.
Because braided sutures are woven from multiple fibres, there are microscopic gaps between these fibres.
If a wound has even a microscopic amount of contamination, the tiny spaces act like a capillary sponge.
Contaminated fluid is drawn up through the weave of the thread. Bacteria then hide in the microscopic space in the braid.
White blood cells are generally too large to enter these gaps, so bacteria can survive there and multiply, which can eventually lead to wound infection.
Suture Sizes Explained
Sutures are sized on the USP scale, where more zeros mean a thinner thread. A metric size gives the diameter in tenths of a millimetre.
The tensile strength of the suture is matched to the tension of the skin where the wound injury is located.
If a clinician is working on a facial cut where the skin is thin and delicate, then a 5/0 or 6/0 suture is typically used. To put it into context, these size sutures are as fine as a human hair.
NHS Scotland guidance lists using 3/0 or 4/0 size sutures for the limbs, and 2/0 or 3/0 for the scalp.
Sites under tension need a thread with enough strength to hold. Using a thinner thread in these areas of the body puts the thread at risk of failing.
Suture Sizing Guide
| USP size | Metric size | Diameter | Typical site |
|---|---|---|---|
| 7/0 | 0.5 | 0.05 mm | Fine work |
| 6/0 | 0.7 | 0.07 mm | Face |
| 5/0 | 1 | 0.10 mm | Face |
| 4/0 | 1.5 | 0.15 mm | Limbs |
| 3/0 | 2 | 0.20 mm | Limbs and scalp |
| 2/0 | 3 | 0.30 mm | Scalp |
Suture Needles
A suture needle is not like a sewing needle. Firstly, it is curved, usually in a 3/8 circle. This allows the clinician to thread the suture with a simple twist of their wrist.
Curvature is measured as a fraction of a circle. A 3/8 circle is a shallow arc and is most used for most skin closure.
A 1/2 circle curves more tightly and is often used in confined spaces where there is little room to turn the needle.
Skin closure often uses reverse cutting needles. A standard cutting needle is shaped like a triangle, with the sharp cutting edge on the inside of the curve.
If you drag that inside curve through the tissue towards a wound, the sharp edge is pointing where you are pulling and wants to cut through the piece of skin you are trying to capture.
A reverse cutting needle flips the triangle so that the sharp cutting edge is on the outside of the curve, while the flat side is on the inside.
As the clinician pulls the needle up and out, the flat side bears against the fragile skin, directing the cutting force away from the tear, minimising collateral damage.
Suture Thread Length
Thread length is the length of suture attached to the needle.
A shorter thread, such as 45 cm, is usually enough for a single interrupted stitch on a small wound.
A longer thread, such as 70 cm or 75 cm, is better suited for continuous closures or deeper layers, where the thread is used for several passes.
The WMS B. Braun range offers a variety of suture sizes, needle configurations, and thread lengths for minor surgical procedures.
Scar Prevention
With the suture chosen, the next consideration is scar prevention. In wound closure, tension in the skin is the enemy of healing.
When the skin is cut, its natural elasticity pulls the edges apart. If you use a loop of thread around the top layer of skin and force the edges together, you fight the skin's natural elasticity.
Stitches tied too tightly can cut into the skin as it swells, a bit like an egg slicer.
To stop this from happening, deep absorbable sutures are often used to close the lower layers. This removes dead space and takes tension off the skin edges.
By the time you get to the surface, the top layer of skin should rest together on its own. Surface sutures then align the edges. The aim here is called wound edge eversion.
Scars do not stay static. Over a year the collagen the scar produces will naturally contract, shrink and sink inward.
If a clinician sews the skin so it lies flat on day one, 12 months later the contracting collagen will pull the scar down and cause a valley on the skin.
Therefore, clinicians need to stitch the skin in anticipation of the future.
To counter the sinking effect, clinicians pass the needle through the tissue in a path shaped like a brandy glass, wider at the base than at the surface.
When clinicians tie the loop, it forces the edges of the skin to come together and tip upward, called eversion.
As the months pass and the scar inevitably contracts and sinks, it pulls the raised edges down until they settle flat with the surrounding skin.
Wound Closure and Suturing FAQs
What are sutures made of?
Absorbable sutures are made from materials such as polyglactin 910 and glyconate, which the body breaks down.
Non-absorbable sutures are made from materials such as polyamide (nylon), polypropylene, and silk.
How long do absorbable sutures take to absorb?
Absorbable sutures take anywhere from under 10 days to over 6 months (180+ days) to be fully absorbed by the body.
How fast a suture is absorbed by the body depends on the material used and whether you are measuring wound support strength (tensile strength) versus total absorption time (when the physical material vanishes entirely).
B. Braun lists about 42 days for Novosyn® Quick.
56 to 70 days for Novosyn®.
And 60 to 90 days for Monosyn®.
Novosyn® keeps 40 to 50% of its tensile strength at 21 days.
What is the difference between absorbable and non-absorbable sutures?
Absorbable sutures break down in the tissue, so they usually do not need removal.
Non-absorbable sutures stay in place and keep their strength for longer, so they may need removal once the wound has healed.
Which is better, a monofilament or a braided suture?
Neither is better in every case.
Monofilament passes through tissue with less friction and leaves fewer places for bacteria to lodge, but it has memory and can need extra knots.
Braided suture handles easily and holds a knot securely, but the gaps between the fibres can harbour bacteria.
What do suture sizes such as 3/0 and 5/0 mean?
Sizes follow the USP scale, where more zeros mean a thinner thread, so 5/0 is finer than 3/0.
The metric size gives the diameter in tenths of a millimetre, so 3/0 is metric 2, or about 0.2 mm.
What size suture is used on the face?
NHS Scotland guidance lists 5/0 or 6/0 for the face.
It lists 3/0 or 4/0 for the limbs and 2/0 or 3/0 for the scalp. Check your local protocol for other sites.
When should a wound not be sutured?
NHS Scotland guidance advises against closing wounds more than 12 hours old, with an exception for scalp wounds that are not infected.
It states not to suture pretibial lacerations, which are closed with adhesive strips instead.
What is the difference between a 3/8 and a 1/2 circle needle?
Both describe the curve of the needle as a fraction of a circle.
A 3/8 circle is a shallower arc and is commonly used for skin.
A 1/2 circle curves more tightly, which helps in confined spaces.
B. Braun Suture Range
A suture should work with you and the wound. The four B. Braun families available at WMS offer absorbable and non-absorbable options, monofilament and braided constructions, and a variety of sizes, so you can find the right suture for your patients.
The B. Braun suture range available at WMS:
| Family | Material and construction | Absorption | Listed uses | USP sizes |
|---|---|---|---|---|
| Monosyn® | Glyconate, monofilament, uncoated | 60 to 90 days | Gastrointestinal, gynaecology and obstetrics, urology, skin closure, paediatrics, ligatures | 6/0 to 2 |
| Novosyn® | Polyglactin 910, braided, coated | 56 to 70 days, with 40 to 50% strength at 21 days | Gynaecology, ophthalmic, urology, ligatures, general surgery, microsurgery | 8/0 to 2 |
| Novosyn® Quick | Polyglactin 910, braided, coated | About 42 days | Short-term support: skin closure, episiotomy, oral mucosa, paediatrics, urology, ligatures | 6/0 to 2 |
| Dafilon® | Polyamide, monofilament | Not absorbed | Soft tissue approximation and ligation, including microsurgery | 11/0 to 5 |
The B. Braun range available at WMS offers a variety of suture sizes, needle configurations, and thread lengths across the different suture families, helping healthcare professionals select products suited to their clinical requirements.
Shop B. Braun SuturesResources
• NHS Scotland Suturing Guidance (PDF)
• Dafilon® | B. Braun
• Dafilon® Product Brochure (PDF)
• B. Braun Suture Indication Guide (PDF)
• B. Braun Sutures Pocket Guide (PDF)
• Novosyn® Product Brochure (PDF)
Disclaimer: This article is for information and education only and does not replace clinical judgement, local protocol, or the manufacturer's instructions for use. Check the current instructions for use before you use any product.