The two biggest considerations when choosing a suture are the location and tension of the wound. Other important considerations are tensile strength, knot strength, handling, and tissue reactivity. Sutures are divided into two major groups:
Absorbable – lose the majority of their tensile strength in less than 60 days. They are generally used for buried sutures and do not require removal.
Non-absorbable – maintain the majority of their tensile strength for more than 60 days. They are generally used for skin surface sutures and do require removal postoperatively.
Suture needles also come in a variety of shapes and sizes. Curved needles are almost exclusively used in dermatological surgery. Cutting needles move through the tissue more easily and may have their primary cutting edge on the inside of the curve (conventional cutting) or outside of the curve (reverse cutting). The benefit of reverse cutting is that the tapered puncture left by the suture is directed away from the wound edge and therefore tissue tearing is less common. Non-cutting round needles cause even less tissue tearing and may be especially useful in delicate areas and fascia.