Background: Deep absorbable stitches should provide a firm closure, hemostasis, and good wound-edge eversion, but this is not always achieved with standard techniques. Objective: We sought to investigate alternative techniques that can rapidly and reliably achieve these results. Methods: We evaluated the fully buried horizontal mattress suture. We compared this technique with the previously described fully buried vertical mattress, partially buried mattresses, and standard reticular dermal and subcutaneous sutures. Results: The fully buried horizontal mattress can provide excellent wound-edge approximation and eversion. It is particularly useful for shallow defects and narrow spaces where a deep stitch is required but technically difficult to insert. Overall, this method offers excellent final cosmesis, and individual sutures can be quickly and reproducibly placed with minimal practice. For very deep defects that require dead-space closure, the fully buried vertical mattress may be preferable. Conclusions: The buried horizontal mattress suture has wide applicability as the buried stitch in a bilayer repair.
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