Mattress Sutures

The 3 main reasons for using mattress sutures:

Firstly, to increase the interphase or contact between the raw surface areas
of two opposing wound sides. This is especially important when you want
to optimize the time it takes for a wound to heal, especially when one
closes a fistula. For example, closing an oroantral fistula (an opening
between the oral and maxillary sinus cavities).

Secondly, to enhance eversion. You just simply have so much more

eversion when using a mattress suture up to the point where you may get
opening of the wound edges. Consider the far-near suturing technique in
this instance which is simply a variation of the vertical mattress suture.

Thirdly, the mattress suture brings a lot more volume or quantity of tissue to
the closure area, and thus the chances of dehiscence are significantly
reduced. Take care though not to tie mattress sutures too tightly as it may
cause tissue strangulation and result in necrosis of the tissue on the suture-
tissue contact areas.

Horizontal mattress sutures

This suturing technique is used to create moderate tension to prevent
hemostasis and to improve wound tension strength for better healing. The
horizontal mattress is also effective at everting wound edges and provides
fair approximation. However, care must be taken to not tighten excessively
or tissue ischemia can result.

Vertical mattress sutures

The vertical mattress technique is an excellent choice for achieving wound
edge eversion and approximation. The technique can be used on either
thin or thick skin and utilizes two bites. The first bite approximates the
wound edges and the second reduces edge tension. The downside is that
vertical mattress sutures can only remain in place for between five to seven
days or risk is high for permanent crosshatch marks.
Near and far sutures
Also called the far-near-near-far suture or the pulley suture. This is a
variation of the vertical mattress suture favored by some surgeons.

The far and near suture is a modified vertical mattress stitch that uses the
tension created by a pulley action to close wound tissue. Because the
pulley stitch reduces the surface area of large wounds of which closure
cannot be accomplished completely by traditional side-to-side sutures, it is
an excellent technique for areas such as the legs and scalp. Pulley sutures
can be used as temporary assisting stitches, such as lessening tension for
buried sutures, or they can be left in for later removal. If pulley stitches are
used they must be removed promptly in order to avoid crosshatch scarring.