This fine structural study of the suture, its development, structure, and response to rapid expansion has shown that the sutural complex is best described in terms of the functional activity of two cell populations, namely, the osteocytic and fibrocytic series, which have the ability to remodel the tissues which they form. It is suggested that the previous detailed descriptions of differences in fiber orientation and vascular distribution reflect functional activity of a suture at any given time rather than immutable anatomic characteristics. Development of the suture and its rapid expansion showed many similarities in that growth during development and orthopedic expansion both separate the joint. If the initial inflammatory aspect of rapid expansion is ignored, the response of the suture is one of osteogenesis and fibrillogenesis, followed finally by remodeling. It is also suggested that sutural expansion involves injury followed by a proliferative repair phenomenon which, in other tissues, usually leads to the formation of scar tissue. However, the ability of sutural connective tissue fibroblasts to remodel ultimately leads to regeneration of the suture. Finally, programmed cell death has been shown to be an important feature in the development of the suture.