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Thirdly, the mattress suture brings a lot more volume or quantity of tissue to
the closure area, and thus the chances of dehiscence are significantly
reduced. Take care though not to tie mattress sutures too tightly as it may
cause tissue strangulation and result in necrosis of the tissue on the suture-
tissue contact areas.
The far and near suture is a modified vertical mattress stitch that uses the
tension created by a pulley action to close wound tissue. Because the
pulley stitch reduces the surface area of large wounds of which closure
cannot be accomplished completely by traditional side-to-side sutures, it is
an excellent technique for areas such as the legs and scalp. Pulley sutures
can be used as temporary assisting stitches, such as lessening tension for
buried sutures, or they can be left in for later removal. If pulley stitches are
used they must be removed promptly in order to avoid crosshatch scarring.