General Surgery
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, you can also place a simple continuous pattern. 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
G Kelmer et al. Simple techniques to decrease tension on sutured wounds in horses, Equine vet. Educ. (2022) 34 (2) 67-72