d. Horizontal Mattress Suture. In this type of suture, the two lines of suture lie
parallel to one another in a horizontal plane. The needle enters on the far side of the
wound and exits on the near side. Then, the pattern is reversed; the needle enters on
the near side of the wound and exits on the far side of the wound. The suture is tied
(1) Advantages. The horizontal mattress suture everts the skin edges
powerfully. A single horizontal mattress stitch can take the place of two simple ties,
thus saving time. This suture is less likely to rip through the skin.
(2) Disadvantages. Puckering may occur if too much pressure is exerted.
There is less control than with other types of sutures.
Figure 2-12. The horizontal running suture.
e. Subcuticular Suture. A subcuticular suture is essentially a running
horizontal mattress stitch. This suture is placed just below the dermal-epidermal
junction. Enter the skin three to four millimeters from one end of the wound. Burrow
through the deep tissue to emerge in the subcuticular plane at the apex of the wound.
Then, pass the suture through the subcuticular tissue on alternate sides of the wound.
The point of entry should be directly across from the exit of the previous stitch.
(1) Advantages. This type of stitch avoids suture marks and is best suited
for straight lacerations. Using absorbable suture material is excellent in cases where
the patient cannot be relied on to return for suture removal.
(2) Disadvantages. Subcuticular suturing is more difficult to learn. Also,
this type of suturing takes time to perform.