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Suturing Techniques: Horizontal Mattress Sutures vs BandGrip

Sutures have been used as the primary method of wound closure throughout human history. Today’s surgeons not only have a variety of materials to choose from when it comes time to close, but also a wide range of techniques that fit the situation. While many of them continue to rely upon traditional closure methods, more and more surgeons are turning to exciting new technologies that allow them to close wounds faster and more effectively.

The Need for Different Suturing Techniques

Not every wound is the same. Depending upon the location, length, and depth of a wound, different suturing techniques may be required. A simple cut or small incision, for instance, may require nothing more than a running suture, in which a single strand is looped through the skin repeatedly to pull the wound edges together much like a sewing stitch. Deeper wounds, however, often call for more specialized forms of closure.

Interrupted Sutures

Most surgical incisions are closed with some form of interrupted stitch. This technique uses individual strands for each loop. Minimally invasive (as far as sutures go), interrupted stitching makes a single puncture mark on either edge of the wound and the knot is tied securely to the side of the incision. While this technique distributes tension across the wound, the single entry point still places all of the strain in one place, making it difficult to tighten the suture without tearing the skin or cutting off circulation. Furthermore, since only one strand is used, interrupted sutures are typically not very deep and close only one layer of tissue. This technique often results in the familiar track mark scarring pattern.

Vertical Mattress Sutures

In situations where deeper layers need to be closed, surgeons often use a vertical mattress suture technique. This approach still uses only one strand, but it actually loops through the skin twice. The first loop penetrates to the deeper layer of tissue while the second closes the surface layer. Once completed, the double strands are stacked vertically, which gives this stitch its name. There are two entry points on each side of the wound, one closer than the other. The double loop nature of the suture makes it more secure than an interrupted stitch, but it still runs the risk of placing too much tension on the skin and can potentially cut off circulation if tied too tightly. 

Vertical mattress sutures can potentially leave more substantial scars, especially if the wound edges are not closed symmetrically. As a result, they should typically be removed between four to six days, after the lower layer of tissue has begun to heal.

Horizontal Mattress Sutures

Closing large wounds presents unique challenges. The wound edges are typically farther apart, which means pulling them together will put much greater strain on the skin. In such cases, the suture is inserted farther from the fragile wound edge and penetrates deeply enough to incorporate additional tissue into the loop. After the first loop is completed, the same strand is run through the wound again alongside it and then tied off. This effectively creates a double stitch that better distributes tension along the suture and the healthy tissue incorporated into the loop.

Horizontal mattress sutures are often used to close wounds temporarily so that another form of stitching can be used to close more securely. Since the loops exert a great deal of pressure upon the skin surface, bolsters (a form of compressible cushion) are often placed between the surface of the skin and the exterior portion of the loop. This minimizes the risk of strangulation, necrosis, and scarring. Like vertical mattress sutures, horizontal sutures should be removed after three to five days to prevent unpleasant scarring.

The BandGrip Alternative

While horizontal mattress sutures have long been used to close larger wounds, they are difficult and time-consuming to use correctly, and even in the best-case scenario, they can cause further complications or lead to negative cosmetic outcomes.

BandGrip Micro-Anchor Skin Closures offer a less invasive alternative to horizontal mattress sutures when it comes to closing large wounds, especially where more fragile tissue is involved. Thanks to its patented micro-anchor technology, BandGrip gently grips the wound edges to pull incisions closed without placing excessive tension on the skin. The device can be applied by any healthcare professional and can be removed by the patient when healing is completed. Since the micro-anchor hooks don’t penetrate the skin deeply enough to reach nerve endings, BandGrip is not only painless to apply and remove, but it also greatly reduces the risk of infection.

Where horizontal mattress sutures will need to be removed after a few days, BandGrip can be used for surgical closure and completely eliminate the need for a return visit to the patient’s medical provider. The smooth, waterproof surface also supports increased ambulation and even allows the patient to take a shower 24 hours after application. Studies have shown that wounds closed using BandGrip feature better cosmetic outcomes, with far less scarring than similar wounds closed using tradition techniques.

To learn more about how BandGrip’s revolutionary micro-anchor technology works, check out our latest video or request a sample for a first-hand look.

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