VERTICAL MATTRESS SUTURE TECHNIQUE

VERTICAL MATTRESS SUTURE TECHNIQUE

The vertical matrix suture technique is generally preferred in deep wounds or when a mass such as tumor, cyst is removed from the subcutaneous tissue level. With the application of the technique, the wound area is closed at the subcutaneous and epidermal levels. By providing tissue approximation at two levels, the tensile force on the wound is minimized.

Far-Far Passing

1. Dermis tissue is gently lifted with forceps.
2. The needle is placed perpendicular to the skin surface at a distance of about 4 mm from the wound edge. In cases where greater tensile is required in the wound area, it may be more than 4 mm from the wound edge.
3. Wrist supination is performed by following the curvature of the needle to allow the needle to pass through the dermis tissue.
4. The needle exiting through the tissue is held with forceps and grasped again with the needle holder. It is of great importance that the needle is not held at the tip with forceps. If the needle is held by the tip, the tip of the needle may become blunt and may result in tissue trauma during the operation.
5. The opposite edge of the wound is gently lifted with forceps. The needle is placed perpendicular to the interior of the dermis tissue for passage from the inside to outside.
6. Wrist supination is performed by following the curvature of the needle to allow the needle to pass through the dermis tissue. It is preferred that the distance of the needle entry and exit points on the skin to the wound edge be equal.
7. The needle exiting through the tissue is held with forceps and grasped again with the needle holder.
8. The Suture is pulled through the tissue.

Near-Near Passing

1. After the first suture passage, a reverse, superficial transition is made for approximation of the wound edges. The needle is held in the opposite direction and the entrance is made closer to the wound edge than the first suture exit point. In this way, when the second pass is completed, the first entry point and the second exit point remain on the same side, allowing to be knotted.
2. Gently lift the dermis tissue with forceps and place the needle perpendicular to the skin surface.
3. Since the needle is held in the opposite direction, the passage of the needle through the tissue is completed by wrist pronation following the needle curvature.
4. The needle exiting through the tissue is held with forceps and grasped again with the needle holder.
5. The opposite edge of the wound is gently lifted with forceps. The needle is placed perpendicular to the interior of the dermis tissue for passage from the inside to outside.
6. Wrist pronation is performed by following the curvature of the needle to allow the needle to pass through the dermis tissue. It is preferred that the distance of the needle entry and exit points on the skin to the wound edge be equal.
7. The needle exiting through the tissue is held with forceps and grasped again with the needle holder.
8. The Suture is pulled through the tissue.
9. Tissue approximation on the wound area is secured by pull the suture. Tissue trauma and ischemia may occur if the suture is pulled excessively.