horizontal mattress stitch

{{Short description|Suture technique}}

{{Multiple image|direction=vertical|align=right|image1=Horizontal mattress suture.svg|image2=Horizontal mattress.svg|width=200|caption2=Overhead view. Dashed lines are under the skin.}}

The horizontal mattress stitch is a suture technique used to close wounds. It everts skin well and spreads tension along the wound edge.{{Cite book

| last = Zuber

| first = TJ

|chapter=Skin biopsy, excision, and repair techniques

| title = Soft tissue surgery for the family physician

| location = Kansas City, Missouri

| publisher = American Academy of Family Physicians

| year = 1998

| pages = 100–6

}}{{cite journal

| doi = 10.1001/archderm.125.9.1189

| last = Coldiron

| first = BM

| title = Closure of wounds under tension. The horizontal mattress suture

| journal = Archives of Dermatology

| year = 1989

| volume = 125

| issue = 9

| pages = 1189–90

| pmid = 2673047}}{{Cite book

| last = Chernosky

| first = ME

| contribution = Scalpel and scissors surgery as seen by the dermatologist

| editor = Epstein E, Epstein E Jr

| title = Skin surgery

| edition = 6th

| location = Philadelphia

| publisher = Saunders

| year = 1987

| pages = 88–127

}} This makes it ideal for holding together fragile skin{{cite journal

| last = Zuber

| first = Thomas

| journal = American Family Physician

| date = December 15, 2002

| volume = 66

| issue = 12

| pages = 2231–6

| title = The Mattress Sutures: Vertical, Horizontal, and Corner Stitch

| url = http://www.aafp.org/afp/20021215/2231.html

| pmid = 12507160

| access-date = October 23, 2009

| archive-date = May 14, 2008

| archive-url = https://web.archive.org/web/20080514035950/http://www.aafp.org/afp/20021215/2231.html

| url-status = dead

}} as well as skin under high tension such as the distant edges of a large laceration or as the initial holding suture in complicated repairs.{{cite book

| last1 = Stegman

| first1 = SJ

| last2 = Tromovitch

| first2 = TA

| last3 = Glogau

| first3 = RG

| title = Basics of dermatologic surgery

| location = Chicago

| publisher = Year Book Medical

| year = 1982

| pages = 42–5

| isbn = 0-8151-8168-X}}

The horizontal mattress is so secure that it can compromise blood supply to the tissue contained within the stitch. This can be helpful to prevent wound bleeding, but it can cause strangulation and skin necrosis if tied too tightly. Sometimes cushioning materials can be placed within the stitch to mitigate this effect.{{cite book

| last = Swanson

| first = NA

| title = Atlas of cutaneous surgery

| location = Boston

| publisher = Little, Brown

| year = 1987

| pages = 30–5

| isbn = 0-316-82474-7}} Like other mattress stitches, the horizontal 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 elsewhere. The knot is parallel adjacent to the wound edge.{{cn|date=February 2022}}

A variation of the horizontal mattress stitch is the figure-of-eight suture. Instead of turning the needle around, the second simple bights are in the same direction as the first. Like the horizontal mattress stitch, it is useful for skin under high tension. It also has the benefit of helping with hemostasis.