How to Tie a Horizontal Mattress Suture

Health care providers use stitches to close large or deep wounds where the skin will not easily stay together and repair itself. The providers learn various types of stitches and choose the technique that helps a specific wound to heal the most effectively. The horizontal mattress suture offers effective wound closure for a wound under tension by spreading the tension out across the length of the wound. Your health care provider may use it as a beginning and ending stitch for a large wound that has a skin flap, where the skin is fragile, or where the skin will roll under.

Things You'll Need

• Surgical soap
• Cotton pad
• Sterile water
• 4 by 4 pad
• Sterile field
• Surgical scissors
• Sterile gloves
• Needle holder
• Needle and suture
• Forceps

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Instructions

• 1

  Clean the wound completely with surgical soap on a cotton pad. Rinse the wound with sterile water and blot dry with a sterile 4-by-4 pad. Cover the clean wound with a sterile field, cutting a hole over the wound with a pair of surgical scissors. Push the edges of the skin together with your gloved finger to close the wound and determine how the edges of the skin must connect to close the wound.

• 2

  Lock a needle holder between the midpoint of the needle and the end where the suture enters the needle. Insert the needle about 6 millimeters from the edge of the wound at either the top or bottom of the tear. Push the end of the needle point past where the edges of the skin meet to a point approximately 6 millimeters on the other side of the wound. Grasp the needle with forceps and lock them around the needle behind the needle point. Release the needle holder and pull the needle out of the tissue. Pull the suture out of the exit hole, leaving about 1 inch of suture tail at the entrance of your first puncture.

• 3

  Lock the needle holder around your needle again and move the point of your needle down about 4 millimeters. Insert the needle point into the skin on the same side of the wound where you just pulled the needle out. Push the needle point past the wound opening to a point approximately 6 millimeters beyond the wound and approximately 4 millimeters below where your first stitch began. Grasp the needle with forceps and lock them in place. Remove the needle holder and pull the needle out of the tissue.

• 4

  Pull the suture through the third and fourth needle holes until all of the slack is removed from the other side of the wound. Tie a knot using the suture tail and the suture you just pulled out of the exit hole. Do not pull the knot tight enough to pucker the skin. Cut the suture approximately 2 millimeters behind the knot. Continue this process until you close the entire length of the wound.