A variation on the horizontal mattress technique to further improve wound edge apposition.
High tension lacerations with concerns for wound healing
Start with a “big bite”, entering the tissue approximately 1cm from the wound edge.
Exit at approximately the same distance on the opposite wound edge.
Reload needle and use a “backhand” approach.
Reenter tissue on the same side, approximately 1cm away along the plane of the wound
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
Pass the needle through the looped suture material
Over tightening the locked mattress suture can compress the wound and lead to tissue strangulation and necrosis