Adjustable horizontal mattress suture: Step 6

(click photo for larger view) On each succeeding day, remove the bandage and grasp the suture beyond the split shot at one end of the wound with forceps, and remove the split shot. Apply gentle traction to the suture while steadying the limb. To hold the tension, place a new split shot on the suture adjacent to the button (see above).

For longer wounds, tightening can be done from both ends of the wound. It may be necessary to administer a neuroleptanalgesic drug to make the suture tightening more comfortable for the patient. Each day after suture tightening, rebandage the limb. If the paw becomes hypothermic or edematous after suture tightening, a biologic tourniquet has been created, and the suture needs to be loosened. Skin edge advancement is greatest during the first two or three days; however, gradual advancement will occur after this time with daily suture tightening.

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