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Vertical Mattress Suture Step-by-Step
Vertical Mattress Suture Step-by-Step
a. The needle is inserted perpendicular to the epidermis, approximately 6 mm distant
to the wound edge. b. With a fluid motion of the wrist, the needle is rotated through the dermis, taking the
bite wider at the deep margin than at the surface, and the needle tip exits the skin
on the contralateral side. (If the needle radius is too small to complete this arc in one movement, this first step may be divided into two, with the needle first exiting between the incised wound edges and then reloaded and reinserted to exit on the contralateral side.) c. The needle body is grasped with surgical forceps in the left hand and pulled
upwards with the surgical forceps as the body of the needle is released from the needle driver. Alternatively, the needle may be released from the needle driver and the needle driver itself may be used to grasp the needle from the contralateral side of the wound to complete its rotation through its arc, obviating the need for surgical forceps. d. The needle is then reloaded in a backhand fashion and inserted at 90 degrees
perpendicular to the epidermis approximately 3 mm from the wound edge on the same side of the incision line as the exit point, between the exit point and the incised wound edge. e. The needle is rotated superficially through its arc, exiting on the contralateral side
of the wound 3 mm from the incised wound edge. f. The suture material is then tied off gently, with care being taken to minimize tension
across the epidermis and avoid overly constricting the wound edges.
As with the simple interrupted suture, care should be taken to avoid skimming the needle superficially beneath the epidermis. This may result in wound inversion as the tension vector of the shallow bite pulls the wound edges outwards and down.
Note that the second throw is placed superficial to the first, deeper farโfar suture, leading to a nested placement of the suture material. This leads to both wound eversion as well as wound-edge approximation.
The Allgรถwer technique involves performing a half-buried vertical mattress suture: the needle is passed from the far entrance point to the interior of the wound. A buried vertical mattress bite is then taken on the contralateral side, and the needle then passes back to the original side, entering near the incised wound edge so that one-half of the wound is closed with a standard vertical mattress suture and the other is closed with a buried vertical mattress.
This technique does not typically permit the same degree of wound-edge apposition as can be accomplished with other transepidermal sutures. In the event that deeper sutures were carefully placed, this may not be a significant drawback, since the wound edges may be well aligned from the placement of these deeper sutures. If not, or if there is a need for improved wound-edge apposition even after placing the vertical mattress suture, additional interrupted sutures may be helpful.