Vertical Mattress Suture
The main indication for use of vertical mattress sutures is to evert the skin edges. By incorporating a large amount of tissue within the passage of the suture loops, the technique permits greater closure strength and better distribution of wound tension. The vertical mattress suture is commonly used in body sites where the wound edges tend to invert, such as the posterior neck or wounds that occur on a concave surface. Some authors believe that a properly placed vertical mattress suture everts wound edges better than any other suture technique.
The vertical mattress suture uses the far-far, near-near system. The far-far suture placement passes 4 to 8 mm from the wound edge, fairly deep in the wound below the dermis. Prior undermining of the wound edges facilitates the placement of the sutures. Following the far-far passage of the needle across both sides of the wound, and before the suture is tied, the needle is placed backwards in the needle driver.
A vertical mattress suture is especially useful in maximizing wound eversion, reducing dead space, and minimizing tension across the wound. One of the disadvantages of this suture is crosshatching. The risk of crosshatching is greater because of increased tension across the wound and the four entry and exit points of the stitch in the skin. A vertical mattress suture provides excellent wound support, and provides superior wound edge eversion. The needle is introduced the wound edge and a deep bite of tissue is taken before exiting the skin in the same position on the opposite wound edge. The needle position is then reversed in the needle holder, and the needle is reintroduced from the second side of the wound and a smaller bite of tissue is taken before exiting on the first side of the wound.
Horizontal Mattress Suture
The horizontal mattress suture is an everting suture technique that spreads tension along a wound edge. This technique is commonly used for pulling wound edges together over a distance, or as the initial suture to anchor two wound edges (holding sutures).These sutures, like the vertical mat-tress sutures, incorporate a large amount oftissue within the passage of the suture thread,and they can serve as effective initial sutures inholding skin flaps in place. The suture is also effective in holding fragile skin together, such as the skin of an elderly patient or a patient receiving chronic steroid therapy.