Objective To analyze the clinical effect of vertical incision cosmetic suture of abdominal wall in gynecological surgery. Methods A total of 140 patients who underwent gynecological surgery in Zibo Central Hospital from February 2021 to February 2022 were randomly divided into control group and observation group, with 70 patients in each group. The control group was treated with conventional suture, and the observation group was treated with vertical incision cosmetic suture of abdominal wall. The suture time, bleeding volume, incision healing and satisfaction were compared between the two groups. Results The suture time, bleeding volume and incision healing in the observation group were better than those in the control group (P<0.05). The satisfaction of scar appearance, pain degree and traction sense in the observation group was better than that in the control group (P<0.05). Conclusion The application of vertical incision cosmetic suture of abdominal wall in gynecological surgery is effective, which can effectively shorten the suture time, reduce the amount of bleeding and promote the healing of incision. Meanwhile, it has positive significance for improving the aesthetics of postoperative incision, and the patient's satisfaction with the suture effect is high, which is worthy of clinical application.