<p>Amidst the escalating demand for biocompatible, biodegradable, and ecologically responsible materials in clinical biomaterial science, filamentous fungal hyphae have emerged as a compelling and underexplored resource for the development of medical sutures. This review consolidates and critically evaluates the utilization of fungal mycelial networks, primarily from filamentous fungi within the Zygomycota phylum, as structural frameworks for biofunctional surgical sutures. The hyphal architecture, characterized by its hierarchical organization, tensile robustness, and inherent biodegradability, presents a biologically congruent alternative to traditional synthetic polymers and animal-derived fibers. Emphasis is placed on fabrication methodologies such as wet-spinning and bioextrusion, which enable the morphological refinement and mechanical tuning of fungal filaments into monofilament and multifilament suture constructs. Furthermore, this review delineates the biocompatibility profiles, degradation kinetics, and sterilization challenges associated with fungal-based materials, while addressing regulatory considerations and translational hurdles. Collectively, the synthesis of interdisciplinary insights highlights the potential of filamentous fungal hyphae as a paradigm-shifting innovation in surgical sutures and sustainable medical textiles.</p> Graphical abstract <p></p>