Brief Summary

Mattress sutures promote wound edge eversion, even when skin edges are under tension. This technique combines the advantages of the deep dermal (removing tension from the skin surface) and the epidermal simple interrupted suture (wound edge approximation & eversion).

Technique (Vertical Mattress)

1. Start with a “big bite”, entering the tissue approximately 1cm from the wound edge.
2. Exit at approximately the same distance on the opposite wound edge.
3. Reload needle and use a “backhand” approach.
4. Pass more superficially, entering approximately 2mm from the wound edge.
5. Exit at approximately the same distance on the opposite wound edge.
6. Instrument tie.

Alternative (Horizontal Mattress)

1. Start with a “big bite”, entering the tissue approximately 1cm from the wound edge.
2. Exit at approximately the same distance on the opposite wound edge.
3. Reload needle and use a “backhand” approach.
4. Reenter tissue on the same side, approximately 1cm away along the plane of the wound
5. Return to the original entry side, approximately the same distance from the wound edge and along the plane of the wound creating a square of entry/exit points
6. Instrument tie.

Usage

The horizontal mattress technique provides much better hemostasis and therefore poses some risk of tissue necrosis to wound edges. As a result, it may be best used as a temporary suture providing hemostasis and reduced tension while completing a repair with simple interrupted sutures.