Mattress Suture Technique Types and Importance

Why is it called a mattress suture?

The vertical mattress stitch often called vertical Donati stitch (named after the Italian surgeon Mario Donati), is a suture type used to close skin wounds.

When do you use horizontal mattress sutures? 

The horizontal mattress suture is useful for wounds under high tension because it provides strength and wound eversion. This suture may also be used as a stay stitch for temporary approximation of wound edges, allowing placement of simple interrupted or subcuticular stitches.

Types of Mattress Suture

1. Horizontal Mattress Suture

The horizontal mattress suture is an everting suture technique that spreads tension along a wound edge. This technique is commonly used for pulling wound edges together over a distance, or as the initial suture to anchor two wound edges (holding sutures). These sutures, like vertical mattress sutures, incorporate a large amount of tissue within the passage of the suture thread, and they can serve as effective initial sutures in holding skin flaps in place. The suture is also effective in holding fragile skin together, such as the skin of an elderly patient or a patient receiving chronic steroid therapy.

The horizontal mattress suture is initiated by inserting the needle about 4 to 8 mm from the wound edge, slightly farther from the wound edge than for placement of simple interrupted sutures. The needle passes through to the opposite wound edge, where it exits the skin. The needle is placed backward in the needle driver, inserted into the skin about 4 to 8 mm farther down that edge (the edge where the needle has just been passed through), and passed from the far side of the wound back to the near side. The needle exits the skin about 4 to 8 mm down the original wound edge from the original insertion site. The suture is tied gently on the side of the wound where the suturing began.

2. Vertical Mattress Suture

The main indication for use of vertical mattress sutures is to evert the skin edges. By incorporating a large amount of tissue within the passage of the suture loops, the technique permits greater closure strength and better distribution of wound tension. The vertical mattress suture is commonly used in body sites where the wound edges tend to invert, such as the posterior neck or wounds that occur on a concave surface. Some authors believe that a properly placed vertical mattress suture everts wound edges better than any other suture technique.

The vertical mattress suture uses the far-far, near-near system. The far-far suture placement passes 4 to 8 mm from the wound edge, fairly deep in the wound below the dermis. The prior undermining of the wound edges facilitates the placement of the sutures. Following the far-far passage of the needle across both sides of the wound, and before the suture is tied, the needle is placed backward in the needle driver. The near-near placement occurs at a shallow depth (about 1 mm) and should be in the upper dermis. The near-near placement should be within 1 to 2 mm of the wound edge. Following the near-near passage of the needle, both ends of the suture thread should be tied to one side of the wound. These ends are tied so that the knot is on the side where the suture passage began.

Besides the mattress suture, there are still other common suture techniques medical students should master. To improve the techniques and get confidence, a suture pad or suture kit would give help.