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Placing the suture cont.
• Perpendicular exit through skin on second side
• Pull needle through in curve of needle
Vertical Mattress Suture
• Used if skin eversion is required and not possible with simple sutures
• Leaves obvious cross hatching
• Remove early
Horizontal Mattress Suture
• Good eversion
• Useful in thick glaborous skin (feet and hand)
• More ischaemia of wound edges
Subcuticular Suture
• Interrupted or running
• Superficial Dermis
• Place all sutures at same level
• No Suture marks
• Absorbable or non absorbable
Half buried Horizontal Mattress Suture
• Less Strangulation of flap edges
• Leave Knots on one side of wound only (eg. On areola for nipple suturing)
Other Closure Techniques
• Over and Over suture
• Quick• Haemostatic• Useful on scalp• Beware ischaemia
Other Closure Techniques
• Skin staples– Quick
– Temporary use to approximate skin
– Use forceps to evert edges and prevent inversion
– Remove early to prevent skin marks
Other Closure Techniques
• Skin tapes– Approximate
wound edges
– Use dermal sutures to take tension & prevent wound inversion