The hybrid mattress tip stitch is very useful when bringing the tip of an M-plasty into position. Importantly, as with the standard tip stitch, this technique is designed to gently approximate the tissues so that the flap is properly inset in the surrounding skin. While it bears a technical resemblance to the hybrid mattress, it is important to appreciate that the hybrid mattress tip stitch is not designed to work under significant tension, as tension across the suture may lead to necrosis of the delicate and lightly vascularized tip of the flap.
As with the tip stitch, placing set-back dermal sutures, imbrication sutures, or suspension sutures prior to placement of the tip stitch will ensure that the tip itself is not under tension when it is approximated with the surrounding skin.
Note that the near-near step incorporating the flap tip bite is taken just proximal to the tip of the flap, while the initial far-far bite is taken distal to the flap tip. The sling-like effect of this approach forces the tip into place, securing it in its desired position.
The vertical mattress component of this approach helps mitigate the risk of flap tip inversion, an occasional drawback of the standard tip stitch technique.