๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
Buried Vertical Mattress Suture Step-by-Step
Buried Vertical Mattress Suture Step-by-Step
a. The wound edge is reflected back using surgical forceps or hooks. Adequate
visualization of the underside of the dermis is desirable. b. While reflecting back the dermis, the suture needle is inserted at 90 degrees into
the underside of the dermis 4 mm distant from the incised wound edge. c. The first bite is executed by following the needle initially at 90 degrees to the
underside of the dermis and then, critically, changing the direction by twisting the needle driver so that the needle exits in the incised wound edge. This allows the apex of the bite to remain in the papillary dermis while the needle exits in the incised wound edge at the level of the reticular dermis. d. Keeping the loose end of the suture between the surgeon and the patient, the dermis
on the side of the first bite is released. The tissue on the opposite edge is then reflected back in a similar fashion as on the first side. e. The second and final bite is executed by inserting the needle into the incised wound
edge at the level of the reticular dermis. It then angles upwards and laterally so that the apex of the needle is at the level of the papillary dermis. This should mirror the first bite taken on the contralateral side of the wound. f. The suture material is then tied utilizing an instrument tie.
This technique is useful for narrow or shallow wounds, such as those on the scalp and shins.6 It may also be used when adding an additional buried suture in an otherwise largely closed wound, where there is insufficient space to insert a vertically oriented buried suture in the narrow space between two other already-placed sutures.
The needle driver may also be held like a pencil, and the needle may then be rotated through the dermis while reflecting back with the forceps to permit easy visualization.
Wound-edge necrosis has been raised as a potential risk of horizontally oriented suture placement, but in practice, this is only encountered very rarely and as a complication of tightly placed traditional horizontal mattress sutures, rather than with the buried equivalent. This is likely due to a constrictive effect on the incised wound edge, which is not typically seen with buried sutures.