Adjustable horizontal mattress suture: Step 5

(click photo for larger view) Next, place forceps on the suture at the opposite end of the wound. Apply traction on the forceps so that the suture material slides through the dermis and the wound edges advance toward each other. Maintain advancement of the skin edges by placing a split shot on this end of the suture directly adjacent to (on top of) the button (see above).

Go back to the first end of the wound, and use needle holders to remove the split shot. Reposition the split shot in the needle holders. Pull up and hold tension on the suture to advance the wound edges from the first end of the wound. Replace the split shot on the suture adjacent to the first button, and close the split shot to hold the suture tension. Cut off excess suture material about two inches beyond each split shot, and place a bandage over the wound.

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