00:04
Let's talk about the
horizontal mattress stitch.
00:07
We talked about the first and
second step of closing wounds.
00:10
Step one is to find a,
do we have any tension to manage?
And if the answer is yes,
then we manage the tension first,
and then we close the wound
for actual cosmetic approximation.
00:19
So step one,
manage the tension.
00:21
Well, this is one of the techniques
that we use to manage tension.
00:23
Okay, so very simple.
00:24
You've already done
the simple interrupted.
00:26
So let's kind of expand from that.
Okay.
00:29
So no different than
a simple interrupted,
or to take a bite, cross.
00:36
It looks just like
a simple interrupted, right?
Nothing special, nothing crazy.
00:40
So here's where
the horizontal mattress comes in.
00:42
All we have to do is reload this
in a reverse load, okay?
Pull the extra slop out.
00:52
And then we're going to move over
and then go the opposite direction.
01:01
Now, what is that
going to do for us?
Well, by doing that, we're pulling
this tissue together,
and what it will do is
once, twice, over, grab the tail.
01:14
What was on the right was my tail.
So I'm going to go left.
01:18
Okay, left goes right,
right goes left.
01:20
See what's it's
puckering up a little bit?
That pucker is there
to give a little bit of a mountain.
01:28
That mountain is helping
a dermis on the one side
touch the dermis on the other side.
01:33
It guarantees good.
I call it flypaper.
01:36
Okay, we want to have the
base of the wound touching.
01:38
We don't want to have the
upper part of the wound touching
because that's not
the strength layer.
01:42
The strength layer is the base
of the wound, the dermis.
01:45
Okay, the dermis
has to touch the dermis,
and this is sticking up
in the air a little bit.
01:49
That's what we want.
01:50
Okay. This is a tension
management technique.
01:53
So, if I have a wound and retention,
and say I have a lot of swelling,
or I have an extensor surface
at the outside of an elbow,
or outside of a knuckle,
or whatever, I'm worried about this,
or I have a loss of tissue.
02:04
So I know I'm going to be closing
underapproximation tension,
just like an electrical excision
or whatnot.
02:10
I may choose to do even just
one of these in the middle
to help pull that ellipse together.
02:14
And this is just one
of those techniques
that you can do a whole row of,
or you can do just one of
but that said,
these are there to help you
so that your wound approximates
for the tension first,
and then the tissue itself
doesn't see tension.
02:27
Right here,
there's no tension so to speak
up at the edge of the tissue.
It's all managed back here.
02:33
Okay, so let me do another one.
02:37
Open, out through,
open around.
02:47
And I'm coming out
and then going back in,
I'm not going all the way
across in one bite.
02:54
The reason is I want to make sure
that I have good dynamics
and poke in straight down
straight over, straight up.
03:00
I don't want to be slicing through
the whole thing on an angle.
03:03
Once, twice, grab that tail.
03:06
The tail's on the right
so it's going to go to the left
of there pretty barber pole.
03:10
If I go the opposite way,
it doesn't look like that. Does it?
I want to have a nice spiral.
Pull, pull up tighter.
03:16
This is a uglier looking technique,
but it's actually going to be
much more cosmetic in the long run.
03:22
Okay, back and forth.
03:29
And called good.
03:33
Go ahead and practice
a whole row of those.