Procedure

Horizontal Mattress Suture

search

Horizontal Mattress Suture

  • Indications
  1. High tension wound support
    1. Pull wound edges together over significant distance
    2. Holding Suture (anchor wound edges together)
  2. Holds fragile or thin skin together
    1. Using 6-0 Suture at digit web space or Eyelid
  3. Hemostatic effect (e.g. scalp)
  • Contraindications
  • Relative
  1. Areas at risk for scarring (e.g. face)
  • Advantages
  1. Optimizes wound edge eversion
  2. Increased closure strength (distributes tension)
  3. Spreads tension along wound edge
  • Technique
  1. Background
    1. Use non-Absorbable Suture
    2. Four landmark sites (2 on each side of the wound)
      1. Points form a rectangle across lesion
      2. Each point is 4-8 mm from wound edge
      3. Two points parallel to lesion on right (east) side
        1. Point 1 at southeast corner of Laceration
        2. Point 4 at northeast corner (2-4 mm north of 1)
      4. Two points parallel to lesion on left (west) side
        1. Point 2 at southwest corner of Laceration
        2. Point 3 at northwest corner (2-4 mm north of 2)
    3. Images
      1. sutureHorizontalMattressLabel.jpg
  2. Step 1: Across Laceration right (east) to left (west)
    1. Enter wound at Point 1 on right side of wound
    2. Needle passes deep, below Dermis
    3. Exits at point 2 on left side of wound
  3. Step 2: Across Laceration left (west) to right (east)
    1. Continue stitch started in Step 1
    2. Enter wound at point 3 on left side of wound
    3. Exits at point 4 on right side of wound
  4. Step 3: Tie Suture
    1. Knot is between point 1-4 on right side of wound
    2. Tie snugly, but avoid tying too tightly
      1. See complications below
  5. Step 4: Final appearance
    1. Suture exposed between point 2 and 3
    2. Suture exposed between point 1 and 4
  • Complications
  1. Suture tied too tightly, excessive pulling
    1. Excessive wound eversion
    2. Wound scarring
    3. Skin necrosis where Suture strangulates over skin
  • Technique tips (avoid complications)
  1. Do not place Sutures too tightly (see above)
  2. Choose smaller caliber Suture Material (e.g. 5-0)
  3. Remove Sutures early (by day 4-6 for most wounds)
    1. Leave non-mattress Sutures in to prevent dehiscence
  4. Consider use of bolsters placed under Sutures
    1. Rolled 2x2 Gauze placed under points 2-3 and 1-4
    2. Prevents wound strangulation at these points
  • References
  1. Mortiere (1996) Wound Management, p. 50-5
  2. Snell in Pfenninger (1994), Mosby, p. 12-9
  3. Zuber (2002) Am Fam Physician 66(12):2231-6 [PubMed]