Types of Mattress Sutures

Thinking extensively about stitches may not be for the faint of heart, but they're an invaluable procedure for closing up wounds. The mattress suture describes a few techniques that center around eversion of the wound--in other words, pushing the joining edges of the skin a bit outward from the body. This helps keep the scarring less visible as the scars tend to pull back over a period of time. There are three types of mattress sutures.

Vertical Mattress Suture

• The vertical mattress technique is used primarily when doctors fear the wound edges will invert, often around the posterior neck or on a concave portion of the body. According to the American Academy of Family Physicians, many consider the vertical mattress suture the best technique for wound eversion.

  The vertical mattress suture is applied using a "far-far, near-near" technique. The suture is first placed further along from the edge of the wound (around 4 to 8 mm) and deep in the wound below the dermis. A second placement of the suture is applied, this time much closer and shallower (about 1 to 2 mm) from the wound edge in the upper dermis. When that is complete, both ends of the thread are tied on the side where the suture began.

Horizontal Mattress Suture

• Because the horizontal mattress technique helps spread the tension evenly along the edges of the wound, it's often used in anchoring skin edges for a second suturing procedure. It's also effective in holding together more fragile or thin skin and is a good fit for elderly patients.

  The horizontal mattress technique is started relatively far from the wound (about 4 to 8 mm) and passes through to the opposite edge. On this same edge, the suture thread is re-inserted another 4 to 8 mm down, and then passed back to the other edge. The thread is then tied on that edge, the same one it began on. This process is repeated until it encompasses the desired area.

  This technique creates "loops" that compress the skin. The AAFP advises care, though: if the sutures are tied too tightly they "can actually cause strangulation, necrosis, and scarring of the skin." There's also a risk of scarring so early removal may be ideal.

Corner Stitch

• Sometimes wounds don't come in neat lines. For wounds that create corners in a roughly 90 degree angle, a corner stitch often does the trick. Actually a variation of the horizontal mattress suture, the corner stitch holds down both edges of an angle wound (and often also an X- or a Y-shaped wound) without having to add more sutures to each edge.

  Practitioners will start the corner stitch by actually drawing a plumb line as a reference. The line bisects the corner on the opposite side of the angle. The suture thread is inserted next to the plumb line and enters the wound in the deep dermis, 4 to 6 mm from the corner. Forceps will lift the flap of skin so that the thread can pass from one side of the corner to the other. From there the thread is entered back into the wound, again 4 to 6 mm from the corner and finally exits the skin on the opposite side of the line from where it started. Gently tie the thread together to finish the job.