Which stitch is best for everting skin edges and precise approximation of wound edges with little tension?

• A. Vertical Mattress
• B. Simple Interrupted
• C. Horizontal Mattress
• D. Running Subcuticular

Answer: (A)

Vertical mattress suturing is designed to bring skin edges together with precise alignment while distributing tension away from the surface, which helps edges evert rather than gape. The technique uses a deep bite taken well away from the wound edge paired with a superficial bite near the edge on each side; when tied, the deeper bite anchors the tissue and the near-edge bite pulls the edge up, creating slight eversion and an accurate edge-to-edge fit. This combination is especially beneficial in areas under traction or with delicate skin, giving good cosmetic results by maintaining edge position and reducing tearing.

Simple interrupted sutures can approximate but don’t inherently promote eversion or provide the same tension distribution. Horizontal mattress sutures can also achieve eversion and strong closure, but they carry a higher risk of ischemia or heavy tissue induration if tightened excessively and are less precise for edge alignment. Running subcuticular closure sits beneath the skin surface and does not address skin-edge eversion or precise surface edge approximation.