Brief Summary

A variation on the horizontal mattress technique to further improve wound edge apposition.

Indications

High tension lacerations with concerns for wound healing

Technique Description

1. Start with a “big bite”, entering the tissue approximately 1cm from the wound edge.
2. Exit at approximately the same distance on the opposite wound edge.
3. Reload needle and use a “backhand” approach.
4. Reenter tissue on the same side, approximately 1cm away along the plane of the wound
5. Return to the original entry side, approximately the same distance from the wound edge and along the plane of the wound creating a square of entry/exit points. Do not pull the extra suture material through
6. Pass the needle through the looped suture material
7. Instrument tie.

Common Pitfalls

Over tightening the locked mattress suture can compress the wound and lead to tissue strangulation and necrosis