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Basic Surgical Technique, Knots and Sutures

Horizontal mattress suture

David Salim med. stud., Christoffer Bing Madsen med. stud., Magnus Avnstorp MD.


Frequently used everting technique used for closure and epidermal approximation. As other interrupted sutures, it can be used alone for wounds with minimal tension or as a secondary layer after dermis is closed.

Suture material choice

Thinnest as possible. Choice will depend on anatomical localization. 6-0, 7-0 monofilament: face and eyelids 5-0 monofilament: areas with minimal tension 4-0 monofilament: areas with moderate tension 3-0 monofilament: high tension areas

Step by step guide

  1. The needle is inserted perpendicular to the epidermis approx. one-half the radius of the needle distant to the wound edge.
  2. Rotate needle through dermis so the needle tip exits the skin on the contralateral side at an equal distance
  3. Grasp needle body (not tip!) with forceps and pull upward
  4. The needle is then reloaded in a backhand fashion and inserted perpendicular to the epidermis proximal to its exit point on the same side (0.5 mm – 1 cm from the exit point)
  5. Exit on the contra-lateral side proximally from the first point of penetration (with the same distance between the two points on the other side)
  6. The suture material is then tied of using an instrument tie

Running horizontal mattress suture


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