The vertical mattress suture is a suture technique derived from the simple interrupted suture. The technique differs from the interrupted suture in that it is placed deep and wide into the wound edge and another shallower interrupted stitch is placed in the opposite direction nearer to the wound edge. Vertical mattress suturing is an everting technique often used in closing wounds and approximation of the epidermis. Like many other interrupted techniques, it can be used on its own for wounds under minimum tension. It can also be used as an additional layer to assist with everting wound edges when a deep suturing technique has been used in the closure of the dermis.
Characteristics of Vertical Mattress Suturing
The vertical mattress suture follows the pattern of far-far, near-near. The far-far stitch is placed 4-8mm away from the wound edge and resembles the ‘bites’ used in a simple interrupted stitch. Instead of passing the suture over either side of the wound and securing the ends in a knot, however, the vertical mattress suture reinserts the needle again around 1-2mm away from the wound edge. Afterwards, both ends of the suture are secured in a gentle but fitted knot on one side of the wound. The knot should be on the side where the suture passage first started.
Advantages of Vertical Mattress Suturing
Vertical mattress suturing is particularly helpful in the maximization of wound eversion, reducing tension around the wound and lessening dead space. This technique is also very useful for the closure of both shallow and deep tissue layers. They are commonly used for cases where the skin edges have a high possibility of inverting down into the wound. For example, vertical mattress suturing is perfect for wounds on the back of the neck, groin area, and other surfaces that are concave. Due to how this technique distributes tension more equally across the wound, it improves the strength of the closure and the chances of wound dehiscence is reduced.
Disadvantages of Vertical Mattress Suturing
Although vertical mattress suturing is very helpful in wound closure, it is also important to know the weaknesses of this technique. If the knots are not tied correctly, it can cause too much tension or hinder circulation. This can seriously harm tissue layers. If the knots are excessively tight, it can cause necrosis to appear in the skin between the outside suture loops. As there are a higher number of insert and exit points in the suture, there is also a higher risk of scarring occurring. During the wound healing process, the skin can also pull the suture loops down, causing a recognizable cross-hatched scarring pattern, also known as Frankenstein scarring marks. Thus, this technique is usually not used in areas like the face that are cosmetically sensitive.
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