Horizontal and vertical mattress sutures, as well as the corner stitch (see figures for technique), may be used to manage wounds unable to be closed with simple techniques.
Management and Disposition
Vertical mattress suture is a useful technique for deep wounds. It reduces wound tension by acting as both a deep and superficial suture. Horizontal mattress suture is best used for wide, gaping wounds with a risk of increased wound tension after closure (eg, lacerations overlying a joint). Corner stitch is used to close triangular wounds or flaps. A simple interrupted suture cannot be placed to approximate the point of the flap due to a tenuous blood supply and increased chance of dehiscence. Once the corner is secured (see figures), simple sutures are used to repair the rest of the wound, with care taken to place the sutures far enough from the tip to optimize circulation.
Vertical Mattress Suture. The suture is placed by first taking a large deep bite of tissue approximately 1 cm away from the wound edge and exiting at the same location on the other side of the wound. A second small superficial bite is then performed in the reverse direction (A). When the bites are complete (B), tying results in nice apposition of the wound edges (C). This technique is especially useful in areas of lax skin, such as the elbow or dorsum of the hand. (Photo contributor: Michael L. Juliano, MD.)
Horizontal Mattress Suture. Useful in achieving wound edge eversion, the horizontal mattress suture begins with a standard suture throw. A second bite is taken approximately half a centimeter from the first exit (A) and brought through at the original starting edge, half a centimeter from the original entry point (B and C). (Photo contributor: Michael L. Juliano, MD.)
Corner Stitch for Stellate Wounds. The corner stitch may also be used to close stellate lacerations.
Utilization of a mattress suture can aid in wound edge eversion and tension reduction. These sutures are particularly useful in areas where the deep subcutaneous tissues are too fragile for deep sutures (eg, over a joint or shin).