Mastering the Horizontal Mattress Suture

As a medical student or surgical resident, proficiency in suturing techniques is paramount for your future career. While the simple running suture serves as a cornerstone for wound closure, mastering horizontal mattress suture will elevate your skillset.

This blog post will guide you as we will delve into:

  • Step-by-step instructions: Learn the precise execution of each step, ensuring proper wound closure, knot burial, and minimal scarring.
  • Considerations and potential challenges: Identify key points to keep in mind while performing it .
  • Benefits of practicing on a suture pad: Understand the invaluable role of practicing on a UpSurgeOn SkinPad before applying your skills to real-world scenarios.

What: Horizontal mattress suture

  • Technique: The suture gets its name from the way the needle passes through the tissue in a horizontal direction, like a mattress being stitched. It involves taking bites on both sides of the wound, with a horizontal “under the skin” pass in between.
  • Function: It excels at bringing wound edges together under tension.
  • Benefits: This technique is particularly useful for:
    • Wounds under stress where the edges tend to pull apart
    • Areas where good cosmetic outcome is important, such as the face
    • Repairing wounds with uneven or jagged edges

How: Step-by-step explanation

Here’s a breakdown of the steps using the UpSurgeOn SkinPad for practice:

1. Entering the First Side:

  • Gently lift the skin edge with forceps.
  • Insert the needle perpendicular (90 degrees) to the skin surface, about 4mm away from the wound edge (increase bite size for high-tension wounds).

2. Crossing the Wound:

  • Rotate your wrist (supinate) to guide the needle through the deep layer of skin (dermis) and emerge in the middle of the wound on the opposite side.

3. Securing the Needle:

  • Use forceps to hold the needle steady while releasing your needle driver.
  • Regrip the needle at the base with the needle driver.

4. Entering the Second Side:

  • Lift the opposing skin edge with forceps.
  • With the needle now facing away from you, insert it perpendicularly through the dermis from the inside out, using the needle’s curve and wrist supination for smooth passage.
  • Ensure both bites on either side have similar depth and distance from the wound edge for even closure.

5. Completing the First Throw:

  • Grasp the needle with forceps and pull it through the skin, following its curve.
  • You should now have a suture crossing the wound perpendicularly, approximately 4mm from each edge (adjust for tension).

6. Preparing for the Second Throw (Buried Bite):

  • Reload the needle with the point facing away from you. Aim to create another horizontal throw 8-10mm further away (distal) from the first one. This “buried bite” will travel under the skin and back to the original entry point for knotting.

7. Creating the Buried Bite:

  • Similar to step 1, lift the skin with forceps and insert the needle perpendicularly.

8. Navigating the Buried Path:

  • Since the needle is loaded away from you, rotate your wrist downwards (pronate) to guide it through the dermis.
Credits: geekymedics.com

9. Securing the Needle (Second Throw):

  • Use forceps to hold the needle and release the needle driver.
  • Regrip the needle at the base with the driver.

10. Finishing the Buried Bite:

  • Lift the opposing skin edge with forceps.
  • Insert the needle perpendicularly through the dermis, using its curve and wrist pronation to return to the entry point from step 1.

11. Completing the Suture:

  • Grasp and pull the needle with forceps, following its curve as it exits the skin.

12. Tying the Knot:

  • With both suture ends free, proceed to tie a secure knot (e.g., surgeon’s knot) away from and parallel to the wound.

Pro tip: Equal needles bites(of the same depth and distance from the wound) should be taken to allow wound edges to oppose equally and neatly

When to choose it

This kind of suture is particularly useful for:

  • Wounds under tension
  • Areas where good eversion of skin edges is desired (e.g., face)
  • Repair of lacerations with irregular edges

Do and don’ts: common errors to avoid

Uneven bites

Ensure your deep bites capture the full thickness of the dermis for secure closure and avoid:

  • Needles bites not uniform in distance from the wounds
  • Needles bites not perpendicular to the wound
  • Needle Tears: Be mindful of the needle angle and avoid pulling excessively during passes.

Sutures Too Tight

  • Over-tightening can strangulate tissues and impede healing. Aim for gentle eversion of the skin edges.

Practice makes it perfect

The UpSurgeOn SkinPad offers a realistic replica of human skin for suture practice. Here’s how to maximize your training:

  • Simulate Different Wound Types: The pad allows you to practice on various wound configurations.
  • Feel the Needle Resistance: The pad provides a realistic feel of needle penetration and tissue resistance, mimicking suturing in a live patient.
  • Unlimited Practice: Unlike suturing on perishable tissue, the pad allows for repeated practice sessions until you perfect the technique.

By understanding the mechanics of the horizontal mattress suture and practicing on the UpSurgeOn SkinPad, you’ll gain the confidence and skill needed to perform this technique effectively in a clinical setting. Remember, mastery takes time and dedication, so keep practicing!

Mastering the Horizontal Mattress Suture

Beyond the Basics: Simple buried suture

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