Advances in Wound Closure Techniques: Integrating Functional Preservation and Aesthetic Outcomes

Abstract

Wound closure is a cornerstone of surgical practice, extending from acute management to complex reconstructive procedures, with implications for tissue healing, infection prevention, and long-term patient satisfaction. Traditional suturing techniques, including interrupted and continuous methods, remain foundational, offering flexibility in tension management and cosmesis. Recent innovations such as subcuticular suturing with absorbable monofilaments, barbed sutures, and cyanoacrylate tissue adhesives have demonstrated improved operative efficiency, reduced complication rates, and superior short-term aesthetic outcomes. Negative pressure wound therapy and closed incision negative pressure therapy further enhance healing in high-risk patients, minimizing surgical site complications and optimizing scar quality. Scar management strategies, particularly for hypertrophic scars and keloids, increasingly employ multimodal approaches combining conservative measures, intralesional corticosteroids, 5-fluorouracil, and emerging agents like botulinum toxin A to achieve functional and cosmetic restoration. At the reconstructive level, advancements in microvascular anastomosis, including coupling devices, have improved efficiency and reliability in free tissue transfer, although patient- and procedure-specific considerations remain critical. Collectively, these developments reflect a paradigm shift: wound closure is no longer solely a mechanical task, but a deliberate process aimed at preserving tissue function, optimizing aesthetic outcomes, and enhancing overall patient-centered care. Future practice will likely focus on personalized approaches that integrate novel suture technologies, advanced wound therapies, and targeted scar modulation to achieve optimal surgical outcomes.