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Basic Surgical Technique, Knots and Sutures

Vertical 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. 5 mm from the wound edge
  2. With a fluid motion of the wrist, the needle is rotated through the dermis, taking the bite wider at the deep margin than at the surface, and the needle tip exits the skin on the contralateral side.
  3. The needle body is grasped with surgical forceps in the left hand and pulled upward with the surgical forceps as the body of the needle is released from the needle driver.
  4. The needle is then reloaded in a backhand fashion and inserted at 90 degrees perpendicular to the epidermis approximately 3 mm rom the wound edge on the same side of the incision line as the exit point, between the exit point and the incised wound edge.
  5. The needle is rotated superficially through its arc, exiting on the contralateral side of the wound 3 mm rom the incised wound edge.
  6. The suture material is then tied off gently, with care being taken to minimize tension across the epidermis and avoid overly constricting the wound edges.

*Video and illustration of the vertical mattress suture coming soon*

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