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While inversion of a wound is generally not a goal of wound closure, there are some situations where inversion may be a desired effect.  A variation on the horizontal mattress suture is a simple way to create this effect, as described in the video above.

An example of this is when trying to re-create a natural crease over an area of injury, such as the nasolabial folds or the cleft of a chin.  Another example is at the margin of the eye, as shown below:

 

Advice from Dr. Jon Kantor, the author of the Atlas of Suturing Techniques: “the first time you do this technique, you are going to feel like you are doing it wrong.”  This is because, contrary to most simple suturing techniques, you are throwing your suture parallel to the wound and not actually seeing through-and-through the margins of the laceration itself.   So, if you feel like you are doing it wrong…you are probably doing it right!

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