As with any running buried technique, this approach provides the benefit of permitting rapid placement of a long string of tension relieving sutures. The pulley effect of the multiple throws also permits effective closure of wounds under even marked tension.
That said, it is critical to focus on outstanding knot security, since the entire suture line is held in place by the knots at the beginning and end of the set of suture throws.
Adding an additional tacking knot, when utilizing this approach is an option as well. It may provide additional knot security. Alternatively, one could consider placing an additional knot or leaving a longer suture tail when utilizing this approach.
A theoretical benefit of the running approach is that there is less suture material left in situ, since the bulk of retained absorbable suture material is in the knots; as there are knots only at the beginning and end of the row of sutures, this technique theoretically decreases the risk of suture spitting and suture abscess formation. Still, the set-back approach leaves suture material deep to the undersurface of the dermis, and therefore the risk of suture spitting and suture abscess formation is negligible.
This is an easy to execute running buried suture approach; since the suture follows the arc of the needle on the undersurface of the dermis there is no need to change planes, effect a heart-shaped suture placement, or guarantee that the suture exit point is precisely at the inside edge of the lower dermis, as may be needed with the running buried vertical mattress suture.
Accurate suture placement is predicated on having a sufficiently undermined plane, since the entire suture loop lays on the undersurface of the dermis. Therefore, broad undermining is a prerequisite for utilizing this technique, since each throw of the needle begins 2-6 mm distant from the incised wound edge on the undermined undersurface of the dermis.
Suture throws may be placed closer together toward the higher-tension areas at the center of the wound to permit greater mechanical advantage and to allow the pulley effect to have a more profound impact at the center of the wound. The throws may then be spaced farther apart toward the apices where the pulley effect is neither needed nor desired, allowing minimization of the quantity of retained buried absorbable suture material left in the wound.