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An excellent and underutilized technique is the placement of vertical mattress sutures in traumatic wounds, which combines the advantages of the deep dermal (removing tension from the skin surface) and the epidermal simple interrupted suture (wound edge approximation & eversion).

This is an especially useful technique for areas where skin is lax or thin and tends not to hold tension well, such as the shins.  Another time to consider these sutures is when you are trying to close with simple interrupted sutures and find the wound edges naturally trying to invert on closure.

One caution for this technique is that it can sometimes cause too much tension on the superficial skin edges, which reduces skin blood supply and can lead to complications such as strangulation, maceration, infection, and a potentially worse scar.

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