Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Therapy Letter
90 (
6
); 814-816
doi:
10.25259/IJDVL_701_2023
pmid:
38594988

Modified buried continuous vertical mattress suture: A novel technique for closure of long wounds under tension

Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India

Corresponding author: Prof. Somesh Gupta, Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India. someshgupta@aiims.edu

Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Ahuja R, Najeeb A, Gupta S. Modified buried continuous vertical mattress suture: A novel technique for closure of long wounds under tension. Indian J Dermatol Venereol Leprol. 2024;90:814-6. doi: 10.25259/IJDVL_701_2023

Dear Editor,

The vertical mattress suture is a useful technique for closing wounds under tension and achieving wound margin eversion, but may lead to track-marks.1 Closure is done using non-absorbable sutures, which have to be removed later. Placing subcuticular sutures in such wounds under tension may cause wound dehiscence. We propose a continuous, knot-free, buried vertical mattress suture that achieves a tension-free closure with good eversion and also prevents track-marks.

This wound closure technique was employed on two patients. The first patient, a young girl with tuberous sclerosis, had a 4 cm × 1.5 cm fibrous cephalic plaque surgically removed from her forehead [Figure 1a]. The second patient, another young girl underwent the removal of a 4 cm × 0.5 cm naevus sebaceous located in the preauricular region [Figure 1b]. This novel wound closure technique yielded excellent aesthetic outcomes in both the patients [Figures 1c and 1d].

Pre- and post-operative photographs using the modified buried continuous vertical mattress suture for skin closure. A large fibrous cephalic plaque on the forehead extending into the anterior hairline.
Figure 1a
Pre- and post-operative photographs using the modified buried continuous vertical mattress suture for skin closure. A large fibrous cephalic plaque on the forehead extending into the anterior hairline.
Two weeks after excision of fibrous cephalic plaque.
Figure 1b
Two weeks after excision of fibrous cephalic plaque.
A linear plaque of naevus sebaceous on the left preauricular area.
Figure 1c
A linear plaque of naevus sebaceous on the left preauricular area.
The preauricular area 2 weeks’ post-removal of naevus sebaceous plaque.
Figure 1d
The preauricular area 2 weeks’ post-removal of naevus sebaceous plaque.

Both patients underwent simple elliptical excisions (3:1 ratio) under aseptic precautions. After thorough undermining, the deeper closure was performed with interrupted sutures using a 4-0 vicryl with taper-point needle. Thereafter, we used a continuous buried vertical mattress suture to achieve superficial closure and approximate the epidermis. This technique followed two key principles: employing the far-far-near-near method of vertical mattress suturing and ensuring that the needle entered the skin at the exit point of the previous suture, effectively burying the stitch.

Using a 4-0 vicryl with a taper point needle, two angulated bites were taken beyond the wound edge to grasp tissue under the suture. The needle was then passed from the apex of the incision across to the far point on one side of the wound edge (far) [Figure 2a] and was then re-introduced at the previous exit point, advancing across to the far opposite end in a deeper plane (far-far) [Figure 2b]. Next, it was brought out at the near edge on the same side in a superficial plane (far-far-near) and then onto the near opposite edge (far-far-near-near) [Figure 2c]. Each insertion of the needle was done at the previous point of exit. The needle was subsequently passed from this near wound edge in a superficial plane onto the far contralateral edge in a deeper plane, about 0.5–1 cm from the previous VMS. [Figure 2d]. This process was repeated across the wound length. Finally, the suture was brought out beyond the opposite wound apex and secured in the tissue with consecutive angulated bites. Pulling both ends of the suture brought the two wound edges closer. The free ends of the suture were cut just at the surface, resulting in a completely buried suture without a knot, eliminating the need for removal [ Video 1].

Schematic diagram to demonstrate the steps in continuous buried vertical mattress suturing. Two consecutive bites are taken beyond the wound edge to get a hold of tissue under the suture. The needle is then advanced through the apex to the far end (point A) of one of the wound edges in a deeper plane (far).
Figure 2a
Schematic diagram to demonstrate the steps in continuous buried vertical mattress suturing. Two consecutive bites are taken beyond the wound edge to get a hold of tissue under the suture. The needle is then advanced through the apex to the far end (point A) of one of the wound edges in a deeper plane (far).
The needle re-enters the skin through the same exit point (point A) to exit at the far opposite end (point B) in a deeper plane (far-far).
Figure 2b
The needle re-enters the skin through the same exit point (point A) to exit at the far opposite end (point B) in a deeper plane (far-far).
After having passed through point A (far end), the needle re-enters at point B to exit at the near end on the same side (point C) and then re-enters through point C to exit at the near end on the opposite edge (point D) in a superficial plane (far-far-near-near).
Figure 2c
After having passed through point A (far end), the needle re-enters at point B to exit at the near end on the same side (point C) and then re-enters through point C to exit at the near end on the opposite edge (point D) in a superficial plane (far-far-near-near).
After passing through points A, B and C, the needle re-enters the skin through point D and exits the far contralateral edge (point A’) in a deeper plane, about 1 cm from the previous vertical mattress. It again exits at the far opposite end (point B’) and the same process is followed through the length of the wound.
Figure 2d
After passing through points A, B and C, the needle re-enters the skin through point D and exits the far contralateral edge (point A’) in a deeper plane, about 1 cm from the previous vertical mattress. It again exits at the far opposite end (point B’) and the same process is followed through the length of the wound.

Video 1 Video demonstrating the modified buried continuous vertical mattress suturing technique.

When performing this suture, especially for beginners, these key points should be kept in mind: first, always fully pull the suture through after each stitch to prevent poor wound approximation and gaping, as this is a continuous unlocked suture; and second, ensure you have enough suture material ready before starting, as you will not be cutting it at any point during the procedure.

At the two-week follow-up, the wounds showed optimal apposition, with minimal visibility of the needle entry marks. Moreover, there was no need for a non-absorbable suture for epidermal approximation, as the entire wound closure was performed using absorbable vicryl.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Use of artificial intelligence (AI)-assisted technology for manuscript preparation

The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.

Reference

  1. . The mattress sutures: vertical, horizontal, and corner stitch. Am Fam Physician. 2002;66:2231-6.
    [PubMed] [Google Scholar]

Fulltext Views
2,697

PDF downloads
2,066
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections