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Vertical mattress suturing is a technique commonly used in surgery and wound closure to provide strong, eversion, and tension-resistant closure, especially in areas with high tension or where precise alignment of wound edges is crucial for optimal healing. Here's how it works:
Preparation: Before starting the suturing process, ensure that the wound edges are clean, debrided, and properly aligned.
Needle and Thread Selection: Select an appropriate needle and suture material based on the type and location of the wound. Typically, a non-absorbable suture material such as nylon or polypropylene is used for this technique.
Starting the Suture: Begin by inserting the needle through one side of the wound edge, approximately 3-5 mm from the wound margin and at a 90-degree angle to the skin surface. Pull the needle through until approximately half of the suture material remains on one side.
First Bite: Insert the needle across the wound, penetrating the opposite wound edge at the same distance from the wound margin and at a similar depth. This creates the first "bite" of the suture.
Exit and Re-entry: Instead of tying off the suture at this point, the needle is brought back out of the skin on the same side where it initially entered, creating a loop of suture material spanning the wound.
Second Bite: Insert the needle again on the same side of the wound, but this time farther from the wound margin than the initial entry point. The needle should exit through the skin on the opposite side of the wound, mirroring the first bite.
Tying Off: Once both bites are completed, tie off the suture by bringing the ends of the suture material together and securing them with knots. This pulls the wound edges together in a vertical manner, promoting eversion and reducing the risk of wound edge inversion or dehiscence.
Repeat: Depending on the length of the wound and the desired level of closure, the process may be repeated with additional sutures spaced evenly along the wound length.
Vertical mattress sutures are particularly useful in areas with high tension, such as the scalp or extremities, where they help distribute tension across the wound edges and minimize the risk of wound complications such as dehiscence or infection. Additionally, they are valuable for ensuring precise alignment of wound edges, which is crucial for optimal wound healing and cosmetic outcomes.
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