Vertical Mattress Suturing Demonstration

00:05 So let's start with the vertical mattress stitch.

00:07 The horizontal mattress, which is a fantastic technique to approximate tissue and retention.

00:11 However, it does cause the tissue just to invert up and it is a bit unsightly.

00:16 The purpose of that is to have both edges pucker up in the air like this effectively.

00:22 If you don't need quite that much tension management, the vertical mattress is a great resource.

00:27 So poke in far, go deep under the tissue.

00:35 Okay, so a big bite, it's like a big C.

00:38 And flip it around into a backhand.

00:42 And make sure when you poke in about halfway from where it popped out in the edge of the incision.

00:48 You're angling in such a way that you go just through the sidewall of the tissue.

00:52 Okay, just to the sidewall of tissue.

00:55 Not all the way through the thickness.

00:57 That's a common mistake made with this.

00:59 If you want to have the wounds come together.

01:00 Otherwise, you'd basically have a glorified horizontal mattress.

01:04 Okay, and then straight across poke to the tissue and then out.

01:10 Now what happens when you put this together? You'll notice that one to grab the tail cross them was far becomes near.

01:21 Okay, there's a little bit of pucker to this now.

01:30 But nothing like the horizontal mattress as far as how much is sticking up in the air.

01:36 And that's the benefit of this. Far more cosmetic.

01:39 And it's going to give you nice results.

01:43 And those are, there's a bit of a pucker here, where sticks up in the air, but it still is pulling straight across from one side to the other.

01:49 And that's the benefit of this technique.

01:51 If it's done wrong, where you go all the way through both sides, it will look, what I think I see probably most commonly is people that don't do this, right. They make a big bite.

02:01 And they go all the way through just fine.

02:03 They go all the way through the big bite just fine.

02:06 Then they turn around, and they poke all the way through the tissue again, as opposed to going just halfway through the tissue, right? So why is that different? Well, I'll show you sec.

02:18 Farther away, there you go.

02:20 All right, so when I pull this together, One and two, grab my tail. One and two grab my tail.

02:29 Watch, what happens to the tissue just sticks up in the air.

02:33 Just like the horizontal mattress did because effectively, that's all I have is horizontal mattress, except for it doesn't move down the incision as I'm making them, they're both in the same line there.

02:42 Okay, so which one is better? This one or this one? Well, quite honestly, if I'm looking at the top skin, this one.

02:48 Because I've actually put the base manager under tension and have gone through the sidewall the dermis on both sides and approximated them.

02:55 This is way more cosmetic than this.

02:58 There's no reason to do this, when you could do this.

03:00 If you need this much tension management, you should be doing a horizontal mattress anyway.

03:04 Otherwise, this is going to buttonhole in.

03:06 If I pull far enough, you can see how this little piece here gets smaller and smaller, you cannot even see it.

03:12 Good luck getting that out later. Right.

03:13 That's just going to burrow into the patient and they're going to have a lot of pain and try to get that out.

03:17 So be thinking about this as opposed to this.

03:21 The only real difference is when you go through the sidewall, you go across the dermis for the small bite from right in the middle of that as opposed to underneath it for the little bite.

03:34 So big bite to big bite, then halfway back, little bite halfway through the thickness of the dermis and then go cross in halfway because you're to match both sides and pop out and look like that.

03:45 Okay, so that's the benefits of the vertical mattress.

03:49 It's more cosmetic, and actually looks pretty nice.

03:51 Okay, so we'll do a whole row of those.

03:53 We'll practice those.