Pediatric emergency medicine trisk 3384 3384

FIGURE 110.6 Continuous skin sutures. A: The simple continuous running stitch. B: The
continuous interlocking skin stitch. C: The running lateral mattress stitch or continuous halfburied horizontal mattress stitch.

FIGURE 110.7 A–E: The vertical mattress suture. After initially placing a simple interrupted
stitch with a somewhat larger bite, make a backhand pass across the wound, taking small,
superficial bites. When the knot is tied, the edges of the laceration should evert slightly. (From
Grisham J. Wound care. In: Dieckmann RA, Fiser DH, Selbst SM, eds. Illustrated Textbook of
Pediatric Emergency & Critical Care Procedures . St. Louis, MO: Mosby; 1997:676, reprinted
with permission.)

The vertical mattress stitch is useful for deep wounds in which it may be
difficult to tie a simple, deep, interrupted suture. It reduces tension on the wound
and may close dead space within the wound. It essentially combines a deep and
superficial stitch in one suture. The needle is placed deep within the wound
(about 3 mm from the wound edge) and brought out to the opposite skin surface.
It is then brought across the epidermis to approximate the epidermal edges ( Fig.
110.7 ). This stitch takes more time to accomplish and produces more cross
marks, but it provides excellent, exaggerated wound eversion and apposition of
the wound edge. Too tight of a knot can pucker the wound.
The horizontal mattress stitch reinforces the subcutaneous tissue and
effectively relieves tension from the wound edges. It does not provide woundedge approximation as well as the vertical mattress stitch. The needle is passed ½