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.
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.
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.
- 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.
- 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.
- The suture is then tied using either an instrument tie or surgical tying method.
- 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.
- 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.