Horizontal Mattress Lecture

Key Points

Skills On Point Rule #1 of wound closure: Manage TENSION before closure.

When your traditional closure go-to's like the simple interrupted stitch pose a risk of dehiscence from tension or edema, it's wise to consider a technique that will remove the actual incision from the wound closure tension. The horizontal mattress stitch does just that. Your end result of a line of horizontal mattress stitches will be what looks like a line of tension on each side of the incision with the incision rising upward (everting) to close the dead space at the base of the wound.

Benefits: This wound-everting technique reduces the risk of seroma, hematoma, and abscess that can form when dead space is left unclosed. It also will put the wound tension lines away from the incision and allow for a reduced risk of wound dehiscence from tension. Ideal for areas under tension like extensor surfaces such as elbows, knees, ankles, etc. It also is a faster technique since two simple interrupted stitches are done each time you have to stop to tie the knot.

Drawbacks: U-G-L-Y, you ain't got no alibi, you ugly. Not a very cosmetic technique by itself, but there are variations that can be quite attractive and still provide the specific benefits to the patient who would be the recipient of this technique.

Golden Nugget: This will require you to use both forehand and backhand on each interrupted stitch, so just like we talked about in class, get practice with the swivel technique to convert from forehand to backhand and backhand to forehand. The video shows this better than I can describe in text.

Horizontal Mattress Demo