Daily Bolus of LR: Vertical Mattress Suture

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March 1, 2011 by dailybolusoflr

The vertical mattress suture is a useful technique to use to ensure proper wound edge eversion in certain wounds. 


This is a favorite suture when there following conditions exist:

·         There is a small amount of dead space in the wound, but not necessarily enough for a deep suture to be placed. 

o   This is sometimes needed due to the wound itself or sometimes needed because of the location of the wound (ie. elbow where there is a lot of excess tissue)

o    The vertical mattress suture offers the benefit of placing both a deep and a superficial suture in one stitch.

·         Mild amount of tension exists and this type of suture spreads the tension across the two layered closure.


The following technique should be used:


1.     This suture is placed by first taking a large bite of tissue approximately 1 to 1.5 cm away from the wound edge

2.     Cross through the tissue to an equal distance on the opposite side of the wound and exit the skin

3.     Reverse the needle and take for a small bite (1 or 2 mm) at the epidermal/dermal edge to approximate closely the epidermal layer

4.     Both the leading end and the tail of the suture will now be on the same side.

5.     Tie the knot.



Fig 5 has a picture




Trotts Wounds and Lacerations



Linda Regan, MD FACEP

Program Director, Emergency Medicine Residency

Johns Hopkins Medical Institutions


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