The process of suturing uses stitches to close a wound or surgical incision. This fundamental procedure holds tissue edges together, facilitates healing by primary intention, and reduces the risk of infection and excessive scarring. Qualification to perform wound closure depends on medical training, state licensure, and specific institutional privileges. Understanding the professionals authorized to perform this common procedure clarifies patient safety and the legal boundaries of medical practice.
Licensed Independent Practitioners
Wound closure is an inherent part of the training and licensure for medical professionals who operate with the highest clinical autonomy. Medical Doctors (MDs) and Doctors of Osteopathic Medicine (DOs) are the primary practitioners. Their extensive education covers the full spectrum of surgical techniques from medical school through residency, making suturing a core competency and routine procedure in any setting.
Their training ensures a deep understanding of tissue layers, wound tension, and the selection of appropriate suture material, such as absorbable polyglactin or non-absorbable nylon. Surgeons refine these skills through specialized residency and fellowship training, managing complex wounds involving fascia, muscle, and internal organs.
Dentists and Oral and Maxillofacial Surgeons (DDS/DMD) also have the legal authority to suture, primarily in the oral cavity, face, and jaw. General dentists routinely perform closure following extractions or minor periodontal procedures. Oral surgeons, having completed additional surgical residency, manage and suture complex facial lacerations, jaw repairs, and soft tissue trauma.
Advanced Practice Providers
Advanced Practice Providers (APPs) include Physician Assistants (PAs) and Nurse Practitioners (NPs). They undergo post-graduate education, typically at the Master’s level, focusing on comprehensive patient care and procedural competency. Suturing is a standard skill taught in their curricula and reinforced through clinical rotations.
PAs practice medicine in collaboration with or under the supervision of a physician, and wound closure is a routine part of their practice in nearly all settings. They often perform laceration repair in high-volume environments like urgent care clinics and emergency departments. Their training emphasizes selecting the correct technique and material to optimize cosmetic and functional outcomes.
Nurse Practitioners, especially those certified in acute care or emergency medicine, also frequently perform suturing within their authorized scope of practice. Many APPs supplement their foundational training with procedural workshops to ensure competency in advanced techniques, such as complex wound management and intricate flap closures. The ability of PAs and NPs to perform these procedures increases patient access to timely and effective wound care.
Specialized and Assisting Roles
Several specialized and assisting roles are authorized to perform or assist with suturing under specific conditions. Surgical Residents and Fellows are licensed physicians who perform closures under the institutional oversight of their training program and attending physician. This supervised practice allows them to gain the necessary proficiency to transition into independent surgical practice.
Registered Nurse First Assistants (RNFA) are registered nurses who complete specialized education and certification to function as a surgical first assistant in the operating room. A core part of the RNFA role is performing tissue approximation and wound closure, often handling the final layers of suturing under the surgeon’s direct purview.
For most Registered Nurses (RNs) and Surgical Technologists, suturing is not a standard part of their independent practice. Surgical Technologists assist by preparing suture materials and instruments. They are generally not authorized to place stitches themselves, though some may perform basic, superficial closures under the immediate, direct supervision of a surgeon in specific settings.
Regulatory Frameworks and Supervision
State licensing boards and the legal concept of “scope of practice” govern who is qualified to suture. Every healthcare profession is defined by a Nurse Practice Act or Medical Practice Act that outlines the procedures a licensed individual is legally permitted to perform. Suturing, considered a minor surgical procedure, must fall within these state-specific boundaries.
The level of required supervision varies significantly between roles. Physicians can suture autonomously. However, the authority for PAs and NPs is often managed through collaborative practice agreements or protocols established with a supervising physician. This arrangement ensures the supervising physician retains ultimate responsibility for the patient’s care and the delegation of procedures.
In some states, a Nurse Practitioner may have full practice authority, allowing them to suture independently based on their training. Conversely, a Physician Assistant in the same state may require a formal supervisory relationship. This legal framework determines not only who can suture but also the circumstances under which they can perform the procedure. A provider’s qualification to perform wound closure must always be verified against the regulations of the location where they practice.