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Subject: Vertical Mattress Suture Placement
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Instruments for simple interrupted skin suture placement are found in Appendix G and can be ordered through local surgical supply houses.
Suture materials can be ordered from Ethicon, Somerville, NJ (http://ecatalog. ethicon.com/EC_ECATALOG/ethicon/default.asp).
A suggested anesthesia tray that can be used for this procedure is listed in Appendix F.
Skin preparation recommendations appear in Appendix E.
Closure of wounds that tend to invert (e.g., back of the neck, groin, inframammary crease, behind the ear)
Closure of lax skin (e.g., dorsum of the hand, over the elbow)
Anchoring or tension-reducing stitch when moving a skin flap
Skin without enough laxity to close without significant risk of sutures pulling through the skin
Closure of defects on breast tissue (use a running intracutaneous suture closure)
Presence of cellulitis, bacteremia, or other active infection
PITFALL: Pass the suture needle symmetrically through the tissue. Asymmetric bites through the wound edge can cause one edge to be higher than the other. The creation of a shelf, with one wound edge higher, produces cosmetically inferior scars that are prominent because they cast a shadow.
Pearl: If a lot of tension is created by pulling the wound closed, small cloth bolsters made by rolling up the edge of a sponge may be used under the external loops of the suture to spread out the pressure on the skin surface, thereby decreasing the likelihood of necrosis at these points.
PITFALL: Overly tight sutures may produce crosshatch marks.
PITFALL: Novice providers often tie the suture tightly to produce additional eversion. Avoid this temptation, because it results in increased wound scarring.
PITFALL: Tight sutures may produce crosshatch marks.
Suture marks (i.e., railroad marks or Frankenstein marks) from the suture loops on the skin surface
Sutures pulling through the skin, especially with closures without enough laxity to close without significant tension