Horizontal Mattress Suture

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A hortiontal mattress suture takes tension off the wound. For a gaping wound you can place a horizontal mattress suture to approximate the margins, then simple interrupted sutures around it. You can remove the horizontal mattress suture at the end and replace it with simple interrupted sutures. Presented by Jess Mason, MD.

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Greg M. -

Do you ever just leave it in as your primary closure?

Jess Mason -

Great question and a I think different people will answer it differently. My reading on this has been to remove them once you have closed around it and taken the tension off. That is what I do. Other people who I've spoken with do leave them in, but this does potentially increase the risk of scarring. Another approach is to remove that mattress suture after a couple of days, but then you have to bring the patient back twice and that seems like a big waste of time, expenses, and resources.

Michael D. -

Jess, these are amazing videos! When would you use the horizontal vs the vertical suture? Both seem like they would be used to bring together a gaping wound, only with the horizontal suture, its just a temporary measure whereas with the vertical you leave that suture. Is that right?

Jess Mason -

Thanks Michael. I can answer in terms of my own practice since there will be lots of variation and no awesome data on this.

Vertical mattress:
-my go-to for wounds in places where it is hard to get eversion or the wound edges to at least lay flat
-I leave them in for support. Having said that, I don't do a ton of these -- just a couple to get the eversion and the rest would probably be simple interrupted.

Horizontal mattress:
-my go-to for gaping wounds where I need some help approximating the edges. Whenever I'm wishing I had an assistant to push the edges of the wound together for me I make the horizontal mattress my assistant.
-I remove these for the reasons stated in my comment above

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