Closure of wounds under tension. The horizontal mattress suture

Bowen's disease of the leg treated with weekly pulses of 5% fluorouracil cream

“…Bowen's disease of the lower leg may be difficult to treat, particularly in the elderly, who may have thin skin and venous disease. Excision with direct closure may be impossible, and skin grafts or flaps heal poorly on the lower leg 7 . With cryotherapy, morbidity can be high and healing slow 8 .…”

Application of skin traction for surgical treatment of grade IV pressure sore: a clinical report of 160 cases

“…[8][9][10][11] This could be associated with transient local hypoxia that triggers a self-regulatory mechanism of capillaries. [12][13][14][15] Consequently, more capillaries become open as seen in a delayed skin flap. 16 Preoperative traction of skin can considerably reduce tension during stitching.…”

The Gliding Stitch

“…7 A towel clamp should not be used on thin skin including the face, since it may tear. 6 The horizontal mattress suture might compromise the blood supply to the wound area. For this reason, bolsters are sometimes used if the horizontal mattress suture is to be left in for additional support.…”

“…For this reason, bolsters are sometimes used if the horizontal mattress suture is to be left in for additional support. 6 Multiple relaxing skin incisions cause trauma to the surrounding skin with possible scarring. 2 The gliding stitch could be an important addition to the above-mentioned techniques.…”

“…2 Several methods to help in the closure of full-thickness wounds under tension have been described. Among them are undermining widely, utilizing layered closure, use of tissue expanders, 1 use of an assistant to push the wound edges together, ''Pulley stitch'' or ''Far-near-near-far'' suture, 3 Winch stitch, 4 usage of towel clamps, 5 horizontal mattress suture, 6 and multiple relaxing skin incisions. 2 The above-mentioned techniques have some limitations and disadvantages.…”