Three-row vertical abdominal wall plication using interlocking horizontal mattress sutures in abdominoplasty

Correction of abdominal wall musculoaponeurotic (MA) laxity has undergone continual refinement for more than a century, with innovation focusing predominantly on the anatomical extent, location and geometry of MA plication. In contrast, comparatively little attention has been directed towards the biomechanics of the suture construct itself, despite the suture construct representing the principal load-bearing component of the repair. The Interlocking Horizontal Mattress (IHM) suture construct was described by Dona et al. and has demonstrated favourable biomechanical characteristics in tendon repair but has not been described for abdominal wall reconstruction. The IHM suture construct is applied in patients undergoing abdominoplasty with MA laxity extending beyond isolated rectus diastasis. The technique incorporates three vertical rows of plication, with the IHM construct used for the lateral rows and a conventional two-layer midline plication. A retrospective review of all patients undergoing this technique between July and October 2025 was performed to evaluate patient characteristics and postoperative outcomes. Ten patients were identified during this review period where the author performed abdominal wall MA repair incorporating the IHM suture construct, including eight standard abdominoplasties and two circumferential abdominoplasties. All patients experienced an unremarkable postoperative course with no complications attributable to the MA repair during six months of follow-up. The IHM suture construct represents a novel application of an established biomechanical repair principle to abdominal wall MA repair. While this clinical series demonstrates the feasibility and reproducibility of the technique, the article’s broader contribution may be to encourage greater scientific investigation into the biomechanics of abdominal wall repair. Comparative biomechanical studies are now required to determine whether differences in suture construct design translate into meaningful mechanical and clinical advantages. Level IV, therapeutic study.