Adjustable horizontal mattress suture: Step 6 (large photo)
For longer wounds, tightening can be done from both ends of the wound. It may be necessary to administer a neuroleptanalgesic drug to make the suture tightening more comfortable for the patient. Each day after suture tightening, rebandage the limb. If the paw becomes hypothermic or edematous after suture tightening, a biologic tourniquet has been created, and the suture needs to be loosened. Skin edge advancement is greatest during the first two or three days; however, gradual advancement will occur after this time with daily suture tightening.