Ординатура / Офтальмология / Английские материалы / Basic Principles of Ophthalmic Surgery_Arnold_2006

Figure 12.5. Near-far vertical

mattress suture. (Illustration by

Mark M. Miller)

The vertical mattresssuture hasa strong tendencyto evertwound edges, so careshould be taken not to over tighten the knots, in order to avoid excess eversionand a poorly healingwound. In ophthalmology, the vertical mattress suture is most frequently usedwhen closinga lacerated(or incised)eyelid margin, where it provides strengthaswell asaneverting tendency,preventing aneyelid margin "notch."

Near-Far Vertical Mattress Suture

In caseswhere one wishesto raisethe subcutaneoustissue,the near-far mattresssuture is a useful variation (Figure 12.5).The techniqueis largelythe same asthe standardvertical mattress,but the needleinitially is driven proximal to the wound and exits distal to the edgeon the contralateralside. It then enters on the secondside nearthe wound edgeand exits on the initial side far from the wound edge,in a "figure eight" pattern.

Horizontal Mattress Suture

The horizontal mattresssuture is largelyusedto minimize wound tension by displacingtension away from the wound edge(Figure 12.6).To placea horizontal mattresssuture,the surgeonenterson one side of the wound, drives the needleacrossthe underlying tissue,and exits on the opposite side of the wound equidistant from the insertion. The surgeonthen re-enterson the secondsidelaterally, againequidistantfrom the wound edge,and drives the needleback through and out the first side,creatinga "rectangle" out of the suture.The endsof the suture are then tied on the sameside of the wound.