What Does "Eversion" Mean in Suturing?
Eversion refers to the outward turning or rolling of wound edges so they meet slightly raised above the skin surface, rather than lying flat or sunken inward. This is a critical concept in surgical wound closure because proper eversion leads to better cosmetic outcomes as the wound heals and contracts.
Why Eversion Matters
When wound edges are everted during closure, they initially appear slightly raised or "puckered" above the surrounding skin. As the wound heals over weeks to months, natural wound contraction occurs. If edges were initially everted, they flatten to create a level, cosmetically appealing scar. If edges were flat or inverted (sunken inward) at closure, wound contraction causes them to become depressed below the skin surface, creating a visible, cosmetically poor scar 1.
How Mattress Sutures Achieve Eversion
Mattress sutures are specifically designed to create eversion through their unique path through tissue:
- The needle enters and exits the skin at 90° or greater angles, which naturally causes tissue to roll outward 1
- The suture takes a wider, deeper bite of tissue that mechanically forces wound edges upward and outward
- Vertical mattress sutures provide superior eversion compared to horizontal mattress sutures because they take deeper bites perpendicular to the wound edge 2, 3
The Opposite Problem: Inversion
Inadequate needle angling or shallow suture placement leads to tissue inversion—where wound edges roll inward and meet below the skin surface 1. This is the problem you want to avoid, as inverted edges create depressed, noticeable scars after healing.
Clinical Application
For optimal skin closure with good eversion: