The vertical mattress stitch, often called vertical Donati stitch (named after the Italian surgeon Mario Donati), [1] is a suture type used to close skin wounds. 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. [2] [3] [4] [5] Its disadvantage is a relatively high propensity to dig into skin and cause prominent stitch mark scars.
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 or reduced subcutaneous tissue (eg, the shin) that do not provide adequate subcutaneous tissue for dermal closure. [6] It is useful for deep lacerations, 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 stitches 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.[ citation needed ]
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. [2] 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. [2] [7] 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.
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. [7] [8] 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. [9]
An abscess is a collection of pus that has built up within the tissue of the body. Signs and symptoms of abscesses include redness, pain, warmth, and swelling. The swelling may feel fluid-filled when pressed. The area of redness often extends beyond the swelling. Carbuncles and boils are types of abscess that often involve hair follicles, with carbuncles being larger. A cyst is related to an abscess, but it contains a material other than pus, and a cyst has a clearly defined wall.
Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation.
Rhinoplasty, commonly called nose job, medically called nasal reconstruction is a plastic surgery procedure for altering and reconstructing the nose. There are two types of plastic surgery used – reconstructive surgery that restores the form and functions of the nose and cosmetic surgery that changes the appearance of the nose. Reconstructive surgery seeks to resolve nasal injuries caused by various traumas including blunt, and penetrating trauma and trauma caused by blast injury. Reconstructive surgery can also treat birth defects, breathing problems, and failed primary rhinoplasties. Rhinoplasty may remove a bump, narrow nostril width, change the angle between the nose and the mouth, or address injuries, birth defects, or other problems that affect breathing, such as a deviated nasal septum or a sinus condition. Surgery only on the septum is called a septoplasty.
A wound is a rapid onset of injury that involves lacerated or punctured skin, or a contusion from blunt force trauma or compression. In pathology, a wound is an acute injury that damages the epidermis of the skin. To heal a wound, the body undertakes a series of actions collectively known as the wound healing process.
The scalp is the anatomical area bordered by the human face at the front, and by the neck at the sides and back.
A skin condition, also known as cutaneous condition, is any medical condition that affects the integumentary system—the organ system that encloses the body and includes skin, nails, and related muscle and glands. The major function of this system is as a barrier against the external environment.
An abrasion is a partial thickness wound caused by damage to the skin and can be superficial involving only the epidermis to deep, involving the deep dermis. Abrasions usually involve minimal bleeding. Mild abrasions, also known as grazes or scrapes, do not scar or bleed because the dermis is left intact, but deep abrasions that disrupt the normal dermal structures may lead to the formation of scar tissue. A more traumatic abrasion that removes all layers of skin is called an avulsion.
A facelift, technically known as a rhytidectomy, is a type of cosmetic surgery procedure used to give a more youthful facial appearance. There are multiple surgical techniques and exercise routines. Surgery usually involves the removal of excess facial skin, with or without the tightening of underlying tissues, and the redraping of the skin on the patient's face and neck. Exercise routines tone underlying facial muscles without surgery. Surgical facelifts are effectively combined with eyelid surgery (blepharoplasty) and other facial procedures and are typically performed under general anesthesia or deep twilight sleep.
Mastopexy is the plastic surgery mammoplasty procedure for raising sagging breasts upon the chest of the woman, by changing and modifying the size, contour, and elevation of the breasts. In a breast-lift surgery to re-establish an aesthetically proportionate bust for the woman, the critical corrective consideration is the tissue viability of the nipple-areola complex (NAC), to ensure the functional sensitivity of the breasts for lactation and breast-feeding.
The horizontal mattress stitch is a suture technique used to close wounds. It everts skin well and spreads tension along the wound edge. This makes it ideal for holding together fragile skin as well as skin under high tension such as the distant edges of a large laceration or as the initial holding suture in complicated repairs.
Incision and drainage (I&D), also known as clinical lancing, are minor surgical procedures to release pus or pressure built up under the skin, such as from an abscess, boil, or infected paranasal sinus. It is performed by treating the area with an antiseptic, such as iodine-based solution, and then making a small incision to puncture the skin using a sterile instrument such as a sharp needle or a pointed scalpel. This allows the pus to escape by draining out through the incision.
Skin biopsy is a biopsy technique in which a skin lesion is removed to be sent to a pathologist to render a microscopic diagnosis. It is usually done under local anesthetic in a physician's office, and results are often available in 4 to 10 days. It is commonly performed by dermatologists. Skin biopsies are also done by family physicians, internists, surgeons, and other specialties. However, performed incorrectly, and without appropriate clinical information, a pathologist's interpretation of a skin biopsy can be severely limited, and therefore doctors and patients may forgo traditional biopsy techniques and instead choose Mohs surgery.
A surgical suture, also known as a stitch or stitches, is a medical device used to hold body tissues together and approximate wound edges after an injury or surgery. Application generally involves using a needle with an attached length of thread. There are numerous types of suture which differ by needle shape and size as well as thread material and characteristics. Selection of surgical suture should be determined by the characteristics and location of the wound or the specific body tissues being approximated.
The corner stitch is a common suture technique. It used to close wounds that are angled or Y-shaped without appreciably compromising blood supply to the wound tip.
In surgery, a surgical incision is a cut made through the skin and soft tissue to facilitate an operation or procedure. Often, multiple incisions are possible for an operation. In general, a surgical incision is made as small and unobtrusive as possible to facilitate safe and timely operating conditions.
Flap surgery is a technique in plastic and reconstructive surgery where any type of tissue is lifted from a donor site and moved to a recipient site with an intact blood supply. This is distinct from a graft, which does not have an intact blood supply and therefore relies on growth of new blood vessels. This is done to fill a defect such as a wound resulting from injury or surgery when the remaining tissue is unable to support a graft, or to rebuild more complex anatomic structures such as breast or jaw.
A splinter is a fragment of a larger object, or a foreign body that penetrates or is purposely injected into a body. The foreign body must be lodged inside tissue to be considered a splinter. Splinters may cause initial pain through ripping of flesh and muscle, or infection through bacteria on the foreign object.
Scalp reconstruction is a surgical procedure for people with scalp defects. Scalp defects may be partial or full thickness and can be congenital or acquired. Because not all layers of the scalp are elastic and the scalp has a convex shape, the use of primary closure is limited. Sometimes the easiest way of closing the wound may not be the ideal or best way. The choice for a reconstruction depends on multiple factors, such as the defect itself, the patient characteristics and surgeon preference.
Carpal tunnel surgery, also called carpal tunnel release (CTR) and carpal tunnel decompression surgery, is a nerve decompression in which the transverse carpal ligament is divided. It is a surgical treatment for carpal tunnel syndrome (CTS) and recommended when there is constant (not just intermittent) numbness, muscle weakness, or atrophy, and when night-splinting no longer controls intermittent symptoms of pain in the carpal tunnel. In general, milder cases can be controlled for months to years, but severe cases are unrelenting symptomatically and are likely to result in surgical treatment. Approximately 500,000 surgical procedures are performed each year, and the economic impact of this condition is estimated to exceed $2 billion annually.
A ladder stitch, or mattress stitch, is a stitch which can be used to invisibly close seams from the outside of the garment or item. It is primarily used to close seams on stuffed items, such as pillows, mattresses, down coats or stuffed toys, where, after the stuffing is added, there is no access to the back of the fabric. It can also be used to repair split seams on these items or garments, or to alter clothing.