The vertical mattress stitch, often called vertical Donati stitch (named after the Italian surgeon Mario Donati), is a suture type used to close skin

wound A wound is a rapid onset of injury that involves laceration, lacerated or puncture wound, punctured skin (an ''open'' wound), or a bruise, contusion (a ''closed'' wound) from blunt force physical trauma, trauma or compression. In pathology, a '' ...

s. The advantages of the vertical mattress suture are that it provides closure for both deep and superficial layers, and also allows perfect eversion and vertical opposition of the superficial skin edges. Its disadvantage is a relatively high propensity to dig into skin and cause prominent stitch mark scars.

Uses

The vertical mattress stitch is most commonly used in anatomic locations which tend to invert, such as the posterior aspect of the neck, and sites of greater skin laxity such as closure of lax skin after removing a

dermoid cyst A dermoid cyst is a teratoma of a cystic nature that contains an array of developmentally mature, solid tissues. It frequently consists of skin, hair follicles, and sweat glands, while other commonly found components include clumps of long hair, ...

or reduced subcutaneous tissue (eg, the shin) that do not provide adequate subcutaneous tissue for dermal closure. It is useful for deep

laceration A wound is a rapid onset of injury that involves lacerated or punctured skin (an ''open'' wound), or a contusion (a ''closed'' wound) from blunt force trauma or compression. In pathology, a ''wound'' is an acute injury that damages the epiderm ...

s, where it can replace two layers of deep and superficial sutures. It can help bring the deep layers together alone, allowing several simple interrupted or

running stitch The straight or running stitch is the basic stitch in hand-sewing and embroidery, on which all other forms of sewing are based. The stitch is worked by passing the needle in and out of the fabric at a regular distance. All other stitches are ...

es to close the remaining superficial skin. Vertical mattress sutures are not recommended for sites such as the palm of the hand, where important structures lie fairly superficial to the epidermis.

Technique

The vertical mattress stitch is placed in a "far-far-near-near" order of bites. The "far-far" loop enters and exits the skin surface at a 90 degree angle, some 4 mm to 8 mm from the wound margin. It passes relatively deeply into the

dermis The dermis or corium is a layer of skin between the epidermis (with which it makes up the cutis) and subcutaneous tissues, that primarily consists of dense irregular connective tissue and cushions the body from stress and strain. It is divided i ...

. The "near-near" loop enters and exits the skin surface 1 mm to 2 mm from the wound margin, traversing the wound at 1 mm depth. Because of the precise degree of control that the vertical mattress stitch provides, bites must be symmetrical, especially the depth of the near-near loop, or the wound will invariably misalign and heal with a "shelf" on one side. The knot is tightened only until sufficient opposition and eversion is achieved. Over-enthusiastic tightening increases the likelihood that the suture material cuts into skin, bearing in mind the swelling that will ensue during wound healing. Bolstering (placing small rolls of gauze under the surface loops prior to tightening) prevents the suture material from cutting down into the skin.

Advantages and disadvantages

The vertical mattress stitch has many effects due to its quadruple ability to achieve deep and superficial wound closure, edge eversion and precise vertical alignment of the superficial wound margins. Although, due to its time-consuming nature, many clinicians infrequently pursue such technique. However, its advantage of precise control also means that the vertical mattress stitch is unforgiving of operator error, particularly in regard to poor vertical alignment of edges. As mentioned above, the vertical mattress stitch is prone to dig into skin, like a cheese cutter wire, so is more likely than other suture types to leave "railroad marks" - small scars along the main wound. Bolstering reduces this problem but necessarily increases the complexity of the stitch. Overall, the propensity of the vertical mattress suture to create railroad marks limits its use in cosmetically sensitive areas, such as the face, and it remains imperative to remove it as early as possible when it is used elsewhere on the body.

References

{{reflist Surgical stitches