Far-near near-far modified vertical mattress sutures. Another stitch that serves the same function as a pulley suture is a far-near near-far modified vertical mattress suture. The first loop is placed about 4-6 mm from the wound edge on the far side and about 2 mm from the wound edge on the near side.
The suture is passed deep in the dermis to the opposite side of the suture line and exits the skin equidistant from the wound edge (in effect, a deep simple interrupted stitch). The needle reenters the skin on the same side of the suture line 5 mm to 1 cm lateral of the exit point.
The pulley stitch can serve as a temporary suture that can be left in place or removed, said Dr. Redbord, a dermatologist in group practice in Rockville, Md. Courtesy of Dr. Kelley Pagliani Redbord The pulley stitch and its modifications are effective for closing defects under tension.
The running locked suture is similar to the simple running stitch, but the person passes the needle through the previous suture's loop to lock the suture in place. Another locking running stitch is the interrupted stitch, which is the running stitch with the thread knotted after each suture. A person stitches the running subcuticular suture horizontally into only the dermis layer of skin, not the epidermis. Often a doctor back-stitches into the previous suture to create a tighter bond.
A running subcuticular suture is a buried form of a running horizontal mattress suture. It is placed by taking horizontal bites through the papillary dermis on alternating sides of the wound (see the image below). No suture marks are visible, and the suture may be left in place for several weeks.
Home Techniques Basic Suturing Vertical Mattress Sutures An excellent and underutilized technique is the placement of vertical mattress sutures in traumatic wounds, which combines the advantages of the deep dermal (removing tension from the skin surface) and the epidermal simple interrupted suture (wound edge approximation & eversion).