Since this is a running variation of the fascial plication technique, its efficacy is predicated on both suture material integrity and adequate knot security. The value of the entire row of corset sutures would be nullified by either breakage anywhere along the row of suture material or knot failure. Therefore, its proponents have suggested utilizing a 2-0 monofilament suture in order to mitigate the risk of suture breakage, since this material has significant tensile strength. That said, since this technique is exclusively used when wounds are under marked tension, suture material failure remains a risk. Additionally, adding an extra throw when tying the knots may help mitigate the risk of knot failure.
Another important drawback of this approach is the potential for increased postoperative pain when compared with utilizing dermal sutures alone, or even when compared with placing a single fascial plication suture. Depending on how deep the suture material traverses through fascia and the underlying muscle, pain may sometimes be experienced that is out of proportion to the defect size and depth, particularly since this technique involves the placement of multiple throws of suture material through the fascia.
The lateral bites in the fascia should be taken no closer than 1-2 mm from the undermined edge of the tissue. Taking bites too far laterally, where there is no undermined plane between fascia and dermis, may result in dimpling at the lateral edges. This dimpling occurs when the bites of fascia are directly contiguous with the overlying dermis and epidermis, and the suture's lateral tension on the fascia also pulls on the dermis. While the dimpling may resolve with time, it is best avoided if possible.
While there is a theoretical risk of distortion of the ellipse caused by these running fascial sutures, this is not typically seen in practice. Because this approach entails multiple passes of suture material through the fascia, the risk of pain and infection are theoretically higher than with placing one or two interrupted fascial plication sutures. While this is balanced by the theoretical benefit of the pulley effect of this technique, this pulley effect is only rarely needed even in the largest wounds. Coupled with the chance that the entire line of sutures can be annulled by breakage anywhere in the suture material or a single knot failure, this approach probably should be used less frequently than the standard fascial plication technique.