Suturing – tension relieving suture patterns

Both vertical and horizontal mattress patterns are everting – they force the cut edges outward. NFFN patterns are appositional and bring tissue layers into direct contact with the same layer on the opposite side.

Vertical mattress

Vertical mattress

you can start with the far bite or with the near bites

Horizontal mattress

Horizontal mattress with stents – clinical case

With a mattress suture placed to relieve tension, you can also place a simple continuous pattern across the skin margins. With this approach, you can remove the larger suture used for the mattress pattern after the skin stretches (3-4 days), leaving the more cosmetic simple continuous suture to finish the job.

Near-far-far-near

NFFN between stents – clinical case

You can change the letters around too

Resources

Simple techniques to decrease tension on sutured wounds in horses, Equine vet. Educ. (2022) 34 (2) 67-72

A novel tension relief technique to aid the primary closure of traumatic equine wounds under excessive tension. Equine Vet J. 2024;56:514–521. Shows how to use the plastic inserts in suture packets as stents