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Technique Tip: The Use of a Modified Interrupted Vertical Mattress Suture after Bunion Surgery

Skin closure after bunion surgery can be difficult. The principle reason for this is the excess skin over the medial border of the foot postoperatively. In general terms, the aims of any skin closure technique are to provide approximation of the wound edges with some degree of eversion and provide cutaneous hemostasis while avoiding excess tension on the skin.1,2,3 The vertical and the horizontal mattress sutures are commonly used for skin closure in orthopaedic surgery. When used to close wounds after bunion surgery, the approximation and eversion of the wound edges that is achieved by the vertical mattress suture may be localized to the close vicinity of each stitch. There may still be puckering of the skin and gaping of the edges in the areas between each two consecutive stitches (Figure 1). The use of horizontal sutures in a similar situation can prevent intersuture skin gaping but may not achieve a skin eversion as effectively as that provided by the vertical suture and may even cause some degree of inversion of the skin edges (Figure 2). On the other hand, the use of a modified interrupted vertical mattress suture after bunion surgery helps obtain a satisfactory approximation and eversion of skin edges without the undesired effect of skin puckering (Figure 3). It prevents inter-suture gaping while reducing the incidence of skin edge inversion associated with the horizontal mattress suture. We have performed this suturing technique to close all operative wounds after foot and ankle surgery, mainly using