Vertical Mattress Stitch
Wayne W. LaMorte, M.D., Ph.D., M.P.H. and Christine Hamori, M.D.
Photography and Editing by Michael J. LaMorte
The vertical mattress stitch is particularly useful in situations in which the skin edges have a tendency to invert or turn down into the wound,. e.g. in the palm of the hand.
Path of the vertical mattress stitch:
The vertical mattress stitch consists of “far-far” and “near-near” components. The “far-far” component is similar to the two bites for a simple interrupted stitch. These are about 4 mm from the wound edge. The “near-near” components are bites that are taken very close to the wound edge, and these are responsible for ensuring eversion of the wound edges when the suture is tied.
The first “far” bite is just like the beginning of a simple interrupted stitch – about 4 mm from the wound edge.
The second “far” bite is being placed in the proximal wound edge, and the needle emerges about 4 mm from the wound edge.
The first “near-near” component is placed by reversing the placement of the needle in the needle holder and “backhanding” the needle so that the bite is taken away from the surgeon.
The first “near” bite has been taken, and the needle holder is about to regrasp the needle to complete the bite.
The needle has been regrasped, and now the second “near” bite is being taken on the wound edge furthest away from the surgeon.
Both the short and long strands emerge from the skin surface furthest away from the surgeon, and the needle holder is being positioned to begin an instrument tie.
The first loop of the square knot is formed by wrapping the long strand around the needle holder…
… and the short strand is grasped and pulled back through the loop toward the surgeon, bringing the throw down just tight enough to approximate the wound edges. After second and third throws are added to secure the knot, the next stitch will be placed about 4-5 mm to the right of the first stitch.