This technique was recently compared with the buried vertical mattress suture in a randomized blinded trial. It was found to be superior to the buried vertical mattress suture in terms of eversion, and cosmetic outcomes were deemed to be better than buried vertical mattress sutures based on both physician and patient assessments.
One of the chief advantages of this technique is its ease of execution; 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 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 the first throw of the needle begins 2-6 mm distant from the incised wound edge.
This technique may also be used to minimize dead space when excising a space-occupying lesion such as a cyst or lipoma. In this event, taking the first bite set back even further from the incised wound edge will translate into a larger ridge and will simultaneously minimize the laxity in the central portion of the wound as the dermis is pulled taut so that potential dead space is converted to a hyper-everted wound ridge which will absorb with time.
Finally, a recent study has demonstrated that treating chest keloids with a combination of the set-back suture and postoperative electron beam irradiation led to an almost 98% success rate. The authors posited that the combination of tension reduction across the wound surface coupled with deep suture placement and suture material placement away from the incised wound edge was responsible for this dramatic effect.