Modified vertical and horizontal mattress suture with lateral pull for skin eversion and ease of removal

Background

Mohs micrographic surgeries can be challenging, with the potential concerns of functional and aesthetic impairments. In the closure of Mohs micrographic surgeries, surgeons train to bury vertical mattress sutures to evert wound edges, to use dermal pulleys in high tension areas and to use running subcuticular to prevent track marks.^1,2

Technique

We use a modified vertical and horizontal mattress suture to keep wounds everted and relieve tension. It consists of the needle placed 5–10mm from the wound edge as a deeply seated simple interrupted suture with the exit point aimed 3mm medial from the entry point and exit opposite epidermis at an equal distance from the initial side. The needle then re-enters the skin on the same side as the last exist point and is redirected back across the wound more superficially, penetrating the skin 2–4mm from the wound edge, and finally lateral 6mm from the initial entry point (Fig 1). The final suture is a deeply placed V-shaped vertical and horizontal mattress.

Figure 1.

The modified vertical and horizontal mattress suture with alternating sides of knot producing wound eversion and ease of suture removal.

Discussion

This technique aids reliable eversion of high-tension wounds without compromise in speed and reduction of pain with suture removal. This clinical surgical tip is practical for clinicians in practices that employ ancillary staff to assist in the removal of sutures. With the lateral placement of the knot, surgical assistants and nurses can remove sutures faster and with decreased patient pain. In our experience, this method is particularly useful in surgical closures in high tension areas such as the back, shoulders and thighs.