Stitches have been used to close wounds throughout history, but the last few centuries have seen a number of important innovations in wound closure. While new materials often get the most attention, new suturing techniques have proven to be every bit as valuable. Since not every wound can be closed in the same way, surgeons have developed a variety of new techniques to meet those unique needs. Vertical mattress sutures are one of the most important types of stitching used by surgeons today.
When to Use a Vertical Mattress Suture
Vertical mattress stitches are particularly effective when it comes to closing both deep and superficial tissue layers. Surgeons typically use them in situations where the skin edges are likely to invert or turn down into the wound. Lacerations on the back of the neck, the groin, or other concave surfaces are ideal candidates for vertical mattress sutures.
Since they distribute tension more evenly across the wound, vertical mattress stitches provide better closure strength and reduce the risk of wound dehiscence, in which the tissue layers become partially or completely separated. Since wound dehiscence greatly increases postoperative mortality rates, mattress suturing techniques are an invaluable technique for many forms of surgical closure.
Characteristics of a Vertical Mattress Suture
A vertical mattress stitch consists of two “bites” on each side of the wound. The bites are positioned in a “near-near” and “far-far” arrangement so that one is closer to the wound edge than the other. Inserted about 4 to 8 mm from the wound edge, the “far-far” component is similar to the bites used for a simple interrupted stitch. However, instead of running the suture through each side of the wound and tying the ends off in a knot, the vertical mattress technique reinserts the needle closer to the wound, usually about 1 to 2 mm from the wound edge.
The “far-far” component of the suture passes deeper into the dermis, while the “near-near” bite traverses the wound at a depth of only 1 or 2 mm. Once both passes are completed, the knot is tightened enough to close the wound, but not so tightly that it strains the tissue. By passing across the wound twice at two different depths, a vertical mattress stitch essentially serves as two sutures to achieve deep and superficial wound closure simultaneously.
Disadvantages of Vertical Mattress Sutures
While this suturing technique is useful and effective, it’s not without its share of drawbacks. If the knots are tied improperly, they can create excessive tension or cut off circulation, which can lead to severe tissue damage. When the knots are too tight, necrosis can develop in the skin between the external suture loops.
The increased number of entry and exit points in the stitch also creates more opportunities for scarring to develop. As the natural healing process of wound inflammation and scar formation takes place, the skin can pull the suture loops downward, creating a distinctive cross-hatched (or, less charitably, “Frankenstein”) scarring pattern. Given these risks, vertical mattress sutures are not typically used in cosmetically sensitive areas (like the face).
Ideally, the suture should be removed within five to seven days in order to reduce the risk of scarring. In cases where this isn’t possible, bolsters can be inserted between the suture loops and the skin in order to minimize contact and tension.
A Different Approach to Closure
While vertical mattress sutures remain an effective technique for many situations, the skill and time required to apply them combined with the risk of scarring and tissue damage have left medical professionals looking for a safer, easier alternative to wound closure.
That’s why many of them are turning to BandGrip Micro-Anchor Skin Closures when they need to close deep lacerations involving fragile tissue. Minimally invasive, BandGrip’s patented micro-anchor technology distributes tension more broadly to pull the wound edges together gently and evenly. This delicate touch greatly reduces scarring to improve cosmetic surgical outcomes and overall comfort.
Thanks to BandGrip’s easy-to-use design, it can be quickly applied by any healthcare professional and removed without the need to schedule a return visit to the doctor. Since patients can shower 24 hours after application and don’t need to worry about suture whiskers or staples catching on clothing or their surroundings, they can be up and around faster than patients who received stitches. The waterproof seal created by the bandage facilitates faster healing while also reducing the risk of infection by foreign bacteria.
See how BandGrip’s innovative micro-anchor technology works in our “How it Works” video and be sure to request a sample to get an up-close look.