Horizontal mattress stitch

Horizontal mattress stitch is a suture technique used in surgery and wound closure to approximate the edges of a wound or surgical incision. It is particularly useful in areas where skin tension is high, as it provides strong wound closure with minimal tension on the skin edges. This technique is often employed in both dermatologic surgery and the closure of incisions in other parts of the body.

Technique

The horizontal mattress stitch involves the placement of sutures in a horizontal orientation relative to the wound. The needle is inserted at a point on one side of the wound, brought across to the opposite side, and then reinserted at a point further along the wound edge before being brought back to the initial side. This creates a loop of suture material that lies parallel to the wound edge. The stitch is then tied, bringing the wound edges together. This technique can be repeated along the length of the wound to ensure complete closure.

Indications

The horizontal mattress stitch is indicated in situations where wound tension is high and there is a need for strong, secure wound closure. It is particularly useful for:

• Wounds under high tension
• Areas where wound edges are difficult to approximate
• Situations requiring eversion of the wound edges
• Closure of surgical incisions in areas prone to movement or stretching

Advantages

The main advantages of the horizontal mattress stitch include:

• Even distribution of tension across the wound
• Minimization of wound edge ischemia due to reduced tension
• Effective eversion of wound edges, promoting optimal healing
• Strong and secure wound closure

Disadvantages

Despite its benefits, the horizontal mattress stitch has some disadvantages:

• Potential for increased scarring due to the larger amount of suture material left in the skin
• Risk of tissue strangulation if the sutures are tied too tightly
• May be more time-consuming to place and remove compared to other suture techniques

Removal

Suture removal timing for a horizontal mattress stitch depends on the location of the wound and the rate of healing. Generally, sutures on the face may be removed within 5-7 days, while those in areas of higher tension, such as the back or joints, may be left in place for 10-14 days. Proper technique in both placement and removal is essential to minimize scarring and ensure optimal healing.

Complications

Complications associated with the horizontal mattress stitch are similar to those of other suture techniques and include:

• Infection
• Scarring
• Wound dehiscence
• Tissue necrosis

Conclusion

The horizontal mattress stitch is a versatile and effective suture technique for wound closure, especially in areas of high tension. Its ability to evenly distribute tension and promote wound edge eversion makes it a valuable tool in the surgical and wound closure repertoire. However, careful consideration should be given to its potential disadvantages and complications.