A variation on the horizontal mattress technique to rapidly close longer lacerations. This technique efficiently achieves wound eversion and can be used to approximate high tension wounds quickly before supplementing with deep dermal and simple interrupted sutures for definitive closure.
Indications
Lengthy, linear lacerations with moderate to high tension
Technique Description
Start with a “big bite”, entering the far side of the tissue approximately 1cm from the wound edge.
Exit at approximately the same distance on the near wound edge.
Make an instrument tie and cut the short tail end of the suture
Reload needle and use a “backhand” approach.
Reenter tissue on the near 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.
Reload needle and enter the far side of the tissue 1 cm from the last exit point.
Repeat steps 2-7 until you reach the end of the wound. Leave a loop of excess suture material on the far side.
Using the loop and the needle end of the suture material, secure the repair with an instrument tie.
Common Pitfalls
Gaps can appear in the middle of the wound if the entry points are spaced too far apart. Over tightening the suture can lead to tissue strangulation and necrosis.