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What:

Horizontal mattress suturing is a fairly useful back-pocket trick to have in your repair arsenal.  It’s most useful for high tension wounds especially when the edges are fragile or frayed.

When:

Truth told, I don’t personally use these sutures often for primary repair, as they don’t create as meticulous of wound edge apposition as simple interrupted sutures or vertical mattress sutures.  A slight variation can overcome this problem, but I would start here if you are just familiarizing yourself with this technique.

Why:

I find these sutures most useful for temporary placement amidst a difficult repair with high tension.  Sometimes, it can be difficult to bring wound edges together to facilitate simple interrupted suturing.  The placement of a horizontal mattress suture can overcome this barrier, as shown in this video.

How:

  1. The first throw is made perpendicular to the wound, approximately half the radius of the needle distance from the edge of the wound.  For a larger wound with larger sized needle, this will generally be about 1 cm from the wound edge.
  2. The suture needle is then loaded in a back-handed fashion, and a second throw is made about 1 cm down the wound edge on the same side, again entering perpendicular to the wound and exiting on the side where you began.
  3. The suture is then tied using either an instrument tie or surgical tying method.
  4. While “1 cm” is really just a rough guide, this will be generally the distance across the wound and down the wound should be similar, such that a square box shape is created.
  5. A nice use of this technique is to place the horizontal mattress first to act as your assistant, holding the wound edges approximated while you perform a more meticulous closure.  You can even clip this suture in the end–one less foreign body in the wound to worry about.
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