Sutures are a fundamental medical technique involving the sewing together of tissue edges after an injury or surgical procedure. The materials act as a temporary scaffold, holding the wound margins in close alignment until the body’s natural healing processes can bridge the gap. Proper wound closure is necessary to prevent pathogenic microorganisms from entering the open tissue, which significantly reduces the risk of infection. Accurately aligning the skin layers also minimizes tissue tension, which is a key factor in achieving a favorable cosmetic outcome and reducing scar visibility.
The Core Providers Licensed to Perform Suturing
Physicians, including both Doctors of Medicine (MDs) and Doctors of Osteopathic Medicine (DOs), possess the broadest and most comprehensive training. This training includes extensive wound management and surgical techniques learned over years of residency. They are fully licensed to perform simple to complex suturing and wound repair across all clinical settings.
Physician Assistants (PAs) are also highly trained and routinely perform wound closure as part of their generalist medical education, which includes approximately 2,000 clinical hours. PAs operate under the supervision or collaboration of a physician, and their ability to suture minor lacerations in an emergency room or clinic is a standard expectation of their role. Their training model is closely aligned with the medical model, preparing them to perform a wide range of procedures.
Nurse Practitioners (NPs), who train under a nursing model, are licensed to perform minor surgical procedures like suturing, provided they have received the necessary specialized training. The extent of their independent practice, including the ability to suture without direct physician oversight, varies significantly depending on state-level practice laws. For example, Certified Nurse-Midwives (CNMs) routinely suture tears or perform episiotomy repairs during childbirth.
Registered Nurses (RNs) generally do not perform primary suturing, but an exception exists for those with specialized training, such as the Registered Nurse First Assistant (RNFA) certification. RNFAs work exclusively in the operating room, where they can perform simple suturing under the direct supervision of the operating surgeon. The role of standard RNs is centered on wound care, assessment, and post-procedure monitoring, not the placement of the stitches themselves.
Clinical Environments Where Stitches Are Applied
Emergency Departments (EDs) are the designated setting for the most severe wounds, such as those that involve heavy, uncontrolled bleeding, expose underlying structures like bone or tendon, or are associated with significant trauma. The ED is equipped with the necessary resources and specialist personnel to manage complex repairs, including deeper layer suturing or specialized plastic surgery consultation.
For the majority of common, non-life-threatening cuts, an Urgent Care Center provides a more efficient and cost-effective option. These facilities are staffed to handle minor to moderate lacerations, typically defined as straight cuts less than two inches long that are not gaping widely and do not involve deep tissue structures. Urgent care clinicians are proficient in cleaning, anesthetizing, and closing simple wounds using sutures, staples, or adhesive options.
Outpatient or primary care clinics may also be an option for very minor, recent lacerations, but their primary role in wound management is often follow-up care. A patient will typically return to a primary care setting for the scheduled removal of non-absorbable skin sutures, which is a procedure that requires minimal specialized equipment. This setting is also appropriate for monitoring the wound for signs of infection or complications in the days following the initial closure.
Options Beyond Traditional Stitches
Surgical staples are a common alternative, often used for straight incisions on the scalp or extremities due to their speed of application and strong closure. Staples are made of inert metals and are beneficial in situations where rapid closure of a long wound is necessary, though they may result in less aesthetically pleasing scars than a finely placed suture.
Tissue adhesives, often referred to as medical or skin glue, offer a non-invasive closure method that is particularly useful for small, low-tension wounds with clean, easily approximated edges. The adhesive is a medical-grade cyanoacrylate that polymerizes to form a strong, protective barrier, eliminating the need for a follow-up visit for removal. This method is often preferred for lacerations on the face or in children, as it avoids the pain of local anesthetic injections and provides excellent cosmetic results.
Adhesive strips, such as Steri-Strips, represent the simplest form of mechanical closure. They are best suited for shallow, superficial cuts or to provide additional support after sutures have been placed deep beneath the skin. These strips apply gentle pressure to hold the wound edges together and are minimally invasive, making them suitable for wounds that do not require the structural strength of sutures.