Chapter 5.17: The Shorthand Vertical Mattress Suture

Synonym

Donati suture

Application

This is a modification of the vertical mattress suture, a frequently used everting technique used for closure and epidermal approximation. As with many interrupted techniques, it may be used alone for wounds under minimal tension, such as those formed by either a small punch biopsy or a traumatic laceration. Like its horizontal counterpart, it is also frequently used as a secondary layer to aid in everting the wound edges when the dermis has been closed using a deep suturing technique.

Suture Material Choice

With all techniques, it is best to use the thinnest suture possible in order to minimize the risk of track marks and foreign-body reactions. Suture choice will depend largely on anatomic location and the goal of suture placement.

On the face, a 6-0 or 7-0 monofilament suture may be used, though fast-absorbing gut may be used on the eyelids and ears to obviate the need for suture removal. When the goal of the shorthand vertical mattress suture placement is solely to encourage wound-edge eversion, fine-gauge suture material may be used on the extremities as well. Otherwise, 5-0 monofilament suture material may be used if there is minimal tension, and 4-0 monofilament suture is useful in areas under moderate tension where the goal of suture placement is relieving tension as well as epidermal approximation. In select high-tension areas, 3-0 monofilament suture may be utilized as well.

Technique

1. The needle is inserted perpendicular to the epidermis, approximately 3 mm distant from the wound edge.

2. With a fluid motion of the wrist, the needle is rotated superficially through the dermis, and the needle tip exits the skin on the contralateral side.

3. The needle body is grasped with surgical forceps in the left hand and pulled upward with the surgical forceps as the body of the needle is released from the needle driver.

4. The needle is then reloaded in a backhand fashion and inserted 6 mm distant from the incised wound edge in line with the exit point on the ipsilateral side.

5. While gently pulling upward on the suture material in order to closely approximate the wound edges, the needle is rotated deep through its arc, exiting on the contralateral side of the wound 6 mm from the incised wound edge.

6. The suture material is then tied off gently, with care being taken to minimize tension across the epidermis and avoid overly constricting the wound edges (Figures 5-17A, 5-17B, 5-17C, 5-17D, 5-17E).