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There has been a dramatic increase in the number of surgical procedures performed along with the methods to close even very large and complex wounds. Plastic surgeons have developed the “Reconstructive Ladder” as a method to consider options in wound closure. At the lowest rung, wounds are allowed to heal by secondary intention with periodic dressing changes. At the highest end of the later is free tissue transfer where tissue from one area of the body can be transferred by microsurgical techniques to a recipient site. Direct suture closure is the most common method to close wounds. Sutures are categorized by the diameter, manufacturing technique (monofilament, braided), biodegradation and the type of needle used. Understanding the methods options in wound closure is critical to optimizing the results in patients.