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The horizontal mattress stitch is a suture technique used to close wounds.It everts skin well and spreads tension along the wound edge. [1] [2] [3] This makes it ideal for holding together fragile skin [4] as well as skin under high tension such as the distant edges of a large laceration or as the initial holding suture in complicated repairs.
Other stitches or suturing techniques include: Purse-string suture, a continuous, circular inverting suture which is made to secure apposition of the edges of a surgical or traumatic wound. [13] [14] Figure-of-eight stitch; Subcuticular stitch. A continuous suture where the needle enters and exits the epidermis along the plane of the skin.
The vertical mattress stitch is most commonly used in anatomic locations which tend to invert, such as the posterior aspect of the neck, and sites of greater skin laxity such as the closure of lax skin after removing a dermoid cyst or reduced subcutaneous tissue (e.g., the shin) that do not provide adequate subcutaneous tissue for dermal closure. [6]
The procedure involves running a surgical-grade cord (eg, silk suture) through the fistula tract so that the cord creates a loop that joins up outside the fistula.The cord provides a path that allows the fistula to drain continuously while it is healing, rather than allowing the exterior of the wound to close over.
The corner stitch is a common suture technique. [1] It used to close wounds that are angled or Y-shaped without appreciably compromising blood supply to the wound tip. [2] [3] The corner stitch is a variation of the horizontal mattress stitch, and is sometimes called the "half-buried horizontal mattress stitch". [4]
They tend to absorb this suture at a higher rate. Special precautions should be taken in elderly patients and patients with history of anemia and malnutrition conditions. As with any suture material, adequate knot security requires the accepted surgical technique of flat and square ties. The PDS suture knots must be properly placed to be secure.
The European Hernia Society recommends that in cases where an open approach is indicated, the Lichtenstein technique be utilized as the preferred method. [12] Recent studies have indicated that mesh attachment with the use of adhesive glue is faster and less likely to cause post-op pain as compared to attachment via suture material. [44] [45] [46]
New knots have been described. Other commonly employed knots are surgeon's knot, modified surgeon's knot, single-double other side knot, strangle knot and modified miller's knot. The Surgeon's knot has been a standard ligature but in one study it demonstrated slippage. [4] While the suture is being put in place a knot is used to secure the suture.