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EQUINE VETERINARY EDUCATION / AE / FEBRUARY 2022


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Fig 2: a) An illustration demonstrating the use of a mesh and a mayo mattress suture for tension releasing. b) A doubled mesh spanning a sutured laceration of the upper lip of a horse.


edge of the mesh to distribute tension over a wider area (Fig 2). The technique is especially useful for relieving tension on an area subjected to constant movement, such as a lip or nostril (Fig 2). Horizontal or vertical mattress tension sutures placed well


away from the margin of the wound (Fig 3) can be used to decrease tension at the margin of the wound (Stashak and Schumacher 2016). The wound can be closed before or after the tension sutures are inserted, usually with simple-interrupted sutures or with inverted cruciate sutures placed closer to the skin edge. Vertical mattress tension sutures are less likely to interfere with blood flow to the sutured margin of the wound than are horizontal mattress tension sutures. Sections of rubber or plastic tubing can be placed beneath the loops in the tension sutures to distribute pressure (Fig 3), but tubing should not be used if the wound is to be covered by a bandage, because a bandage places pressure on the tubing causing skin underlying the tubing to necrose. The horizontal or vertical mattress tension sutures are removed in 5–7 days, by which time tension on the approximating sutures has greatly dissipated. Leaving the tension sutures for a longer time may result in suture tracts and pressure necrosis beneath the tubing. The near-far-far-near (NFFN) suture serves as both an


approximating suture and a tension suture. The near component approximates the sides of the wound, and the far component relieves tension on the near component. The loop in the suture increases the strength of the suture and the holding power of the tissue into which it has been placed (Fig 4). In areas when there is less tension, inverted cruciate pattern can be a useful alternative to accelerate the repair (Fig 4).


Walking sutures (Fig 5) can be used to decrease tension


on a sutured wound (Stashak and Schumacher 2016). To place walking sutures, the margin of the wound is undermined, and a suture is placed into the dermis of the skin at the junction of the undermined skin and the underlying subcutaneous tissue on one side of the wound. The suture is then placed through the underlying subcutaneous tissue on


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Fig 3: a) An illustration showing vertical and horizontal mattress sutures for tension releasing over a laceration sutured under tension. b) Horizontal mattress with cerclage wire for primary full-thickness body wall closure in a dehiscing incision to prevent eventration.


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