Fans of the vertical mattress suture, consider this relatively straightforward modification of the technique: shorthand it.
You were probably taught in medical school, as I was, that the vertical mattress suture typically follows a far-far then a near-near pattern of suture placement. But this doesn’t necessarily have to be the rule. Since the suture material ultimately forms a continuous loop, the pattern can simply be reversed and a near-near bite can then precede the far-far bite.
The obvious technical problem is readily apparent: how can that far-far bite be performed effectively once the margins of the wound have already been approximated by the near-near bite? Don’t you need to exit in the center of the wound to achieve the far-far bite?
Herein lies the crux of the shorthand technique: after the near-near bite is placed, roughly 3 mm from each wound edge, the operator then retracts upward on the suture material with the non-dominant hand in order to place the far-far bite, about 6 mm from each wound edge. This aids not only in traversing the tissue effectively to attain that far-far bite, but also has the desired effect of placing the suture material at differential depths–as you raise the tissue near the wound edge, it exaggerates the depth differential between the two throws.
The technique is not without a few disadvantages:
- it is technically a little more challenging to master than the traditional vertical mattress suture.
- since the deeper far-far throw is now placed in a blinded fashion, there is a risk (albeit small) of damaging underlying vascular and nerve structures.
That said, this is a relatively simple modification of a tried-and-true technique that, with a little practice, can actually help you to place your next vertical mattress suture better.
- Jones JS, Gartner M, Drew G, Pack S. The shorthand vertical mattress stitch: evaluation of a new suture technique. Am J Emerg Med.1993;11(5):483-485.
- Snow SN, Goodman MM, Lemke BN. The shorthand vertical mattress stitch–a rapid skin everting suture technique. J Dermatol Surg Oncol. 1989;15(4):379-381.
- Kantor, J. Atlas of Suturing Techniques. Chapter 5.17.