The vertical mattress suture (VMS) is a specialized technique used for closing deep wounds, particularly in areas under high tension or where excellent eversion—the outward turning of skin edges—is desired. It provides a strong, multi-layered closure that helps minimize the risk of the wound edges rolling inward. Given the depth and complexity of this closure, improper removal can introduce infection, cause pain, or disrupt the healing tissue, which is why this procedure should almost always be performed by a trained healthcare professional.
Identifying Vertical Mattress Sutures
The vertical mattress suture is easily distinguished from a simple interrupted stitch by its unique configuration, often described using the “far-far, near-near” pattern. The suture material enters and exits the skin four times, creating a characteristic rectangular shape perpendicular to the wound line.
The “far-far” passes go wide and deep beneath the skin surface, providing strength to hold the deeper layers of the wound together. The “near-near” passes are shallower and closer to the wound edge, designed to achieve the necessary eversion of the skin. This dual-layer approach ensures both deep and superficial support for the healing tissue.
Essential Preparation for Removal
The timing of vertical mattress suture removal is determined by the wound’s location, as different body areas heal at varying rates and are subject to different levels of tension. Sutures on the face are typically removed earliest, around 5 to 7 days, to minimize scarring. Wounds on the trunk or scalp may require 6 to 10 days, while those on the limbs or over joints, which experience more movement and tension, generally remain in place for 10 to 14 days.
A sterile environment and proper supplies are necessary to prevent introducing bacteria into the healing wound site. The required equipment includes a sterile suture removal kit, which contains sharp, pointed scissors and fine-tipped forceps. Antiseptic solution, such as iodine or chlorhexidine, along with sterile gauze, is used to clean the area before and after the procedure. Adequate lighting is also needed to clearly visualize the suture material and the small entry points in the skin, which is a step performed only after the wound has been assessed for signs of infection, such as increased redness or discharge.
Detailed Removal Procedure
Prior to cutting, the area around the suture must be cleaned thoroughly with an antiseptic solution to remove surface contaminants. The primary goal of the removal technique is to ensure that the segment of the suture that has been exposed to the external environment is not dragged through the tissue beneath the skin. This prevents the transfer of bacteria into the healing wound channel.
The first action is to gently grasp the knot of the suture with the forceps and pull it slightly away from the skin surface, which helps create tension and exposes the suture material as it enters the skin. Next, the sterile scissors are used to cut the suture material close to where it emerges from the skin on the side opposite the knot. The cut should be made where the suture material is the cleanest, typically right at the skin’s surface, on one of the near-near loops.
After the cut is made, the knot is gently pulled with the forceps in the direction of the wound line, allowing the entire suture to slide out smoothly. If resistance is met, it is important to stop and check for an embedded thread rather than pulling forcefully, which could damage the healing tissue. Once removed, each suture must be visually confirmed to be intact and accounted for to ensure no fragments remain within the tissue.
Post-Removal Wound Management
Immediately after the sutures have been removed, the newly healed wound edges require continued support to prevent excessive tension from causing the wound to widen. Wound closure strips, commonly known as Steri-Strips, are applied perpendicular to the incision line to provide external stability. These strips act as a temporary barrier and help minimize the stress on the new tissue, which is still significantly weaker than the surrounding skin.
The patient should keep the area clean and dry for the following 24 to 48 hours to allow the skin to fully seal and the closure strips to adhere properly. While showering is generally safe after this period, soaking the wound in a bath or pool should be avoided, as this can weaken the strips and compromise the wound’s integrity. It is important to monitor the site closely for any signs of complication, such as the wound opening up, known as dehiscence, or developing an infection, indicated by persistent swelling, warmth, or the presence of purulent drainage.