Technique
The vertical mattress stitch is placed in a "far-far-near-near" order of bites. The "far-far" loop enters and exits the skin surface at a 90 degree angle, some 4mm to 8mm from the wound margin. It passes relatively deeply into the dermis. The "near-near" loop enters and exits the skin surface 1mm to 2mm from the wound margin, traversing the wound at 1mm depth. Because of the precise degree of control that the vertical mattress stitch provides, bites must be symmetrical, especially the depth of the near-near loop, or the wound will invariably misalign and heal with a "shelf" on one side. The knot is tightened only until sufficient opposition and eversion is achieved. Over-enthusiastic tightening increases the likelihood that the suture material cuts into skin, bearing in mind the swelling that will ensue during wound healing. Bolstering (placing small rolls of gauze under the surface loops prior to tightening) prevents the suture material from cutting down into the skin.
Read more about this topic: Vertical Mattress Stitch
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