FIGURE 110.6 Continuous skin sutures A: The simple continuous running stitch B: The continuous interlocking skin stitch C: The running lateral mattress stitch or continuous halfburied horizontal mattress stitch FIGURE 110.7 A–E: The vertical mattress suture After initially placing a simple interrupted stitch with a somewhat larger bite, make a backhand pass across the wound, taking small, superficial bites When the knot is tied, the edges of the laceration should evert slightly (From Grisham J Wound care In: Dieckmann RA, Fiser DH, Selbst SM, eds Illustrated Textbook of Pediatric Emergency & Critical Care Procedures St Louis, MO: Mosby; 1997:676, reprinted with permission.) The vertical mattress stitch is useful for deep wounds in which it may be difficult to tie a simple, deep, interrupted suture It reduces tension on the wound and may close dead space within the wound It essentially combines a deep and superficial stitch in one suture The needle is placed deep within the wound (about mm from the wound edge) and brought out to the opposite skin surface It is then brought across the epidermis to approximate the epidermal edges ( Fig 110.7 ) This stitch takes more time to accomplish and produces more cross marks, but it provides excellent, exaggerated wound eversion and apposition of the wound edge Too tight of a knot can pucker the wound The horizontal mattress stitch reinforces the subcutaneous tissue and effectively relieves tension from the wound edges It does not provide woundedge approximation as well as the vertical mattress stitch The needle is passed ½