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Subject: Horizontal Mattress Suture
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Surgery tray instruments are listed in Appendix G. Consider adding skin hooks to gently handle the skin flaps. Have at least three fine (mosquito) hemostats to assist with hemostasis while developing large skin flaps.
Suggested suture removal times are listed in Appendix J, and a suggested anesthesia tray that can be used for this procedure is listed in Appendix F. All instruments can be ordered through local surgical supply houses.
Closure of thin or atrophic skin (e.g., elderly skin, eyelids, individuals on chronic steroid therapy)
Eversion of skin defects prone to inversion (e.g., posterior neck, groin, intergluteal skin defects)
Closure of bleeding scalp wounds
Closure of web space skin defects (e.g., finger or toe web spaces)
Closure of wounds under high tension
Skin with poor blood flow
Severe bleeding disorders
Pearl: The distance down the suture line for the second pass is about one half to two thirds of the suture width across the wound.
PITFALL: Although the added eversion may appear beneficial at the time of wound closure, tight knots often produce skin pressure necrosis. Avoid the temptation to tie the horizontal mattress suture tightly.
Suture marks, especially if left in place for more than 7 days
Tissue strangulation and wound edge necrosis if sutures are tied too tightly