๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
Horizontal Mattress Step-by-Step
Horizontal Mattress Step-by-Step
a. The needle is inserted perpendicular to the epidermis, approximately one-half the
radius of the needle distant to the wound edge. This will allow the needle to exit the wound on the contralateral side at an equal distance from the wound edge by simply following the curvature of the needle. 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. c. The needle body is grasped with surgical forceps in the left hand and pulled
upwards 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 90 degrees
perpendicular to the epidermis proximal (relative to the surgeon) to its exit point along the length of the wound on the same side of the incision line as the exit point.
e. The needle is rotated through its arc, exiting on the right side of the wound (relative
to the surgeon) in a mirror image of steps b and c. 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.
Since a wide bite of dermis and epidermis is included in the suture arc, it is particularly important to avoid tying the suture material too tight, as this could lead to wound-edge necrosis. Some surgeons utilize bolsters when utilizing this technique under high tension, such as when a 3-0 suture is used on the back, in an attempt to avoid track marks and reduce the risk of tissue necrosis. A wide array of materials may be used for the bolster, including gauze, dental rolls, or plastic tubing. In practice, bolsters are rarely needed with this technique as long as the bulk of the wound tension has been shifted deep using fascial or dermal buried sutures.