Vertical Mattress Suturing Technique

 The vertical mattress stitch is a suture technique used to close wounds. The vertical mattress technique is mainly used for everting wound edges, at which it is better than any other stich. It is most commonly used in anatomic locations which tend to invert, such as the posterior aspect of the neck or the palm of the hand. It also is good for deep lacerations, where it can replace two layers of deep and superficial sutures. It can help bring the deep layers together alone, allowing several simple interrupted or running stitches to close the remaining superficial skin. It has a far-far-near-near order of bites.

The far stitches emerge 4 to 8mm from the wound edge and pass relatively deeply into the dermis, and the near stitches 1 to 2mm. The bites should be symmetrical on each side of the wound, or the wound may misalign and heal with a "shelf" on one side.Like other mattress stitches, the vertical mattress can sometimes leave small skin scars called "railroad marks;" for this reason it is rarely used on the face, and is removed promptly even when placed elsewhereThe tendency to create these scars limits its use in cosmetically sensitive areas, such as the face. The knot is perpendicular and adjacent to the wound edge.