Horizontal Mattress Suturing Demonstration

00:04 Let's talk about the horizontal mattress stitch.

00:07 We talked about the first and second step of closing wounds.

00:10 Step one is to find a, do we have any tension to manage? And if the answer is yes, then we manage the tension first, and then we close the wound for actual cosmetic approximation.

00:19 So step one, manage the tension.

00:21 Well, this is one of the techniques that we use to manage tension.

00:23 Okay, so very simple.

00:24 You've already done the simple interrupted.

00:26 So let's kind of expand from that. Okay.

00:29 So no different than a simple interrupted, or to take a bite, cross.

00:36 It looks just like a simple interrupted, right? Nothing special, nothing crazy.

00:40 So here's where the horizontal mattress comes in.

00:42 All we have to do is reload this in a reverse load, okay? Pull the extra slop out.

00:52 And then we're going to move over and then go the opposite direction.

01:01 Now, what is that going to do for us? Well, by doing that, we're pulling this tissue together, and what it will do is once, twice, over, grab the tail.

01:14 What was on the right was my tail. So I'm going to go left.

01:18 Okay, left goes right, right goes left.

01:20 See what's it's puckering up a little bit? That pucker is there to give a little bit of a mountain.

01:28 That mountain is helping a dermis on the one side touch the dermis on the other side.

01:33 It guarantees good. I call it flypaper.

01:36 Okay, we want to have the base of the wound touching.

01:38 We don't want to have the upper part of the wound touching because that's not the strength layer.

01:42 The strength layer is the base of the wound, the dermis.

01:45 Okay, the dermis has to touch the dermis, and this is sticking up in the air a little bit.

01:49 That's what we want.

01:50 Okay. This is a tension management technique.

01:53 So, if I have a wound and retention, and say I have a lot of swelling, or I have an extensor surface at the outside of an elbow, or outside of a knuckle, or whatever, I'm worried about this, or I have a loss of tissue.

02:04 So I know I'm going to be closing underapproximation tension, just like an electrical excision or whatnot.

02:10 I may choose to do even just one of these in the middle to help pull that ellipse together.

02:14 And this is just one of those techniques that you can do a whole row of, or you can do just one of but that said, these are there to help you so that your wound approximates for the tension first, and then the tissue itself doesn't see tension.

02:27 Right here, there's no tension so to speak up at the edge of the tissue. It's all managed back here.

02:33 Okay, so let me do another one.

02:37 Open, out through, open around.

02:47 And I'm coming out and then going back in, I'm not going all the way across in one bite.

02:54 The reason is I want to make sure that I have good dynamics and poke in straight down straight over, straight up.

03:00 I don't want to be slicing through the whole thing on an angle.

03:03 Once, twice, grab that tail.

03:06 The tail's on the right so it's going to go to the left of there pretty barber pole.

03:10 If I go the opposite way, it doesn't look like that. Does it? I want to have a nice spiral. Pull, pull up tighter.

03:16 This is a uglier looking technique, but it's actually going to be much more cosmetic in the long run.

03:22 Okay, back and forth.

03:29 And called good.

03:33 Go ahead and practice a whole row of those.