Vertical mattress stitch

Because of the precise degree of control that the vertical mattress stitch provides, bites must be symmetrical, especially the depth of the near-near loop, or the wound will invariably misalign and heal with a "shelf" on one side.

Over-enthusiastic tightening increases the likelihood that the suture material cuts into the skin, bearing in mind the swelling that will ensue during wound healing.

Bolstering (placing small rolls of gauze under the surface loops prior to tightening) prevents the suture material from cutting down into the skin.

As mentioned above, the vertical mattress stitch is prone to dig into the skin, like a cheese cutter wire, so it is more likely than other suture types to leave "railroad marks" - small scars along the main wound.

Overall, the propensity of the vertical mattress suture to create railroad marks limits its use in cosmetically sensitive areas, such as the face, and it remains imperative to remove it as early as possible when it is used elsewhere on the body.