Vertical mattress stitch

A surgical suture technique used for wound closure

Overview

The vertical mattress stitch is a type of surgical suture technique used to close wounds. It is particularly useful for wound closure in areas where the skin is under tension, such as the joints or areas with thick dermis. This technique helps to evert the wound edges, which is crucial for optimal healing and minimizing scarring.

Diagram of a vertical mattress suture

Technique

The vertical mattress stitch involves two main components: a deep and a superficial stitch. The deep stitch penetrates the dermis and subcutaneous tissue, while the superficial stitch is placed more superficially in the epidermis. This combination allows for precise approximation of the wound edges and helps to distribute tension evenly across the wound.

Steps

1. Insertion of the Needle: The needle is inserted approximately 4-8 mm from the wound edge, passing through the skin and exiting on the opposite side at an equal distance. 2. Deep Stitch: The needle is then reinserted on the same side, approximately 1-2 mm from the wound edge, and passed through the dermis and subcutaneous tissue, exiting on the opposite side. 3. Superficial Stitch: The needle is reinserted again on the same side, approximately 1-2 mm from the wound edge, and passed through the epidermis, exiting on the opposite side. 4. Tying the Knot: The suture is tied off, ensuring that the wound edges are everted and aligned.

Applications

The vertical mattress stitch is commonly used in areas where precise approximation of the wound edges is necessary. It is particularly beneficial in:

• Orthopedic surgery
• Plastic surgery
• Dermatologic surgery

This technique is also advantageous in closing lacerations on the face, hands, and other areas where cosmetic outcomes are important.

Suture before and after application

Advantages

• Eversion of Wound Edges: The vertical mattress stitch helps to evert the wound edges, which is crucial for proper healing and minimizing scar formation.
• Tension Distribution: By incorporating both deep and superficial stitches, this technique distributes tension across the wound, reducing the risk of wound dehiscence.
• Versatility: It can be used in various types of tissue and is particularly useful in areas with high tension.

Disadvantages

• Complexity: The technique is more complex than simple interrupted sutures and requires more time to perform.
• Risk of Tissue Ischemia: If tied too tightly, the suture can cause ischemia of the wound edges, leading to tissue necrosis.

Related pages

• Surgical suture
• Wound healing
• Suture techniques