Physicians have used sutures for more than 5000 years. And while they’ve evolved, from linen to silk and even old-school catgut (which is, of course, not made from cats but collagen fibers from bovines and sheep), doctors have been sewing with the same suture materials for decades. But in recent years, new advances in sutures have entered the market with the goal of doing far more than holding tissue together. 

“A suture sits precisely at the tissue interface during the most biologically active and infection-vulnerable phase of healing — the first 1-2 weeks postoperatively,” said Christopher Homsy, MD, a plastic and reconstructive surgeon at Tufts Medical Center, Boston.

That window has inspired researchers to rethink what else a suture can accomplish. Some release antimicrobial or anti-inflammatory medications directly into the wound. Others are being designed to deliver local pain medications or growth factors directly into the surgical site. And more futuristic designs are poised to incorporate sensors capable of detecting changes in pH, temperature, or other biomarkers that could help doctors catch signs of infection or impaired healing before clinical symptoms appear.

Advanced Sutures Already in Use Today

While there are many advanced sutures in testing and development phases, there are mainly two types in use today: antimicrobial sutures and barbed knotless sutures.

Barbed sutures have tiny barbs along the thread that grip tissue, which allows surgeons to close wounds without tying knots. They’re common in minimally invasive surgery (laparoscopic or robotic), plastic surgery, and abdominal procedures. “They’re especially helpful for long closures where you want even tension and speed,” said Jeffrey Michael Karp, MD, professor of anesthesia at Brigham and Women’s Hospital and Harvard Medical School, Boston. These, he said, mainly help with efficiency, not dramatically better healing. “They can reduce stitching time and sometimes overall surgery time,” said Karp.

“Antimicrobial sutures are the most mature and widely adopted,” said Homsy. These include triclosan-coated sutures and sutures incorporating silver nanoparticles or chlorhexidine and octenidine coatings. These sutures are designed to prevent bacteria from growing on the suture or wound, helping to reduce the risk for infection.

“A 2025 systematic review and meta-analysis found that triclosan-containing sutures were associated with significantly fewer surgical site infections compared to sutures without triclosan,” said Homsy. He noted that a separate meta-analysis of more than 10,000 patients who underwent abdominal fascial closure also found triclosan-coated sutures reduced surgical site infections.

Among the more promising drug-eluting sutures in development are those that deliver anti-inflammatories. The researchers behind these highlight that while traditional anti-inflammatories may help with pain, they don’t act specifically on the wound. And if stitches become inflamed, this can slow healing and increase the risk for scarring. These experimental sutures incorporate anti-inflammatory drugs into biodegradable polymer coatings. The drugs are then slowly released into the wound over time.

Smart Sutures

In the age of everything “smart,” sutures are also on the agenda. Researchers are experimenting with smart sutures that can monitor the healing process in real time, potentially giving clinicians an early warning when something isn’t progressing as expected.

These sutures are being designed with biosensors that can monitor changes in pH, temperature, glucose, or wound integrity. Some are even being developed to wirelessly transmit that information to clinicians, with the goal of detecting signs of infection or wound complications before they become serious. They can also enable physicians to monitor healing in real time through continuous feedback.

“The ability to detect an infection at an early stage could revolutionize the post-op experience and that is why post-op care has been lacking,” said Olga Bachilo, MD, a board-certified plastic surgeon and founder of Glamour Plastic Surgery and Med Spa in Houston. These sutures are primarily in clinical trial stages, but Bachilo said preliminary results on some varieties have been promising.

There are also lower-tech versions of smart sutures in development, such as color-changing varieties designed to visibly respond to changes in the wound environment, like shifts in pH that may signal infection or delayed healing. Instead of relying on sensors or wireless connectivity, these sutures could provide clinicians with a simple visual cue during routine wound inspections.

“Color-changing sutures that indicate infection, pH shift, or impending dehiscence via a visible chromatic signal require zero infrastructure change,” said Homsy. “The surgeon closes the wound, and the suture does its diagnostic work passively: visible on routine wound inspection without any reader device, app, or data infrastructure.” This simplicity, he said, may help significantly lower the barrier to adoption. Researchers have even experimented with using natural pigments for these color-changing sutures, such as beet juice.

Looking Ahead

The holy grail for sutures may be those that combine multiple functions into a single thread. Homsy hopes to have access to sutures that pair knotless mechanics with antimicrobial coatings and local drug delivery, and envisions sutures that “sense, respond, deliver, and communicate.”

Researchers are also exploring other next-generation suture technologies, such as regenerative sutures seeded with stem cells to help promote tissue repair and healing, as well as shape-memory sutures that can automatically adjust tension as wounds heal. While some of these approaches have shown promise in the lab, many are still experimental.

And as many surgeons look to the possibility of these smart sutures with excitement, some, like Scott L. Hansen, MD, chief of the Division of Plastic and Reconstructive Surgery at the University of California, San Francisco, said enthusiasm for smart sutures should be balanced with careful evaluation of clinical evidence.

“I don’t think we have any great level 1 evidence that we need to change our techniques,” said Hansen. “Like, having a suture with a drug-eluting coating on there, does it really affect the biology of wound healing? I don’t think we really know that yet.” He said that while many of these technologies are novel on paper, their usefulness in everyday surgical practice remains to be determined. 

The experts quoted had no relevant conflicts. Disclosure information for study authors is available in the original study publications.