As with other running dermal techniques, this approach leaves a fair amount of absorbable suture material in the dermis. Therefore, foreign-body reactions, suture abscess formation, and infection are possibilities. That said, since the entire suture line is secured with a single knot, and since most of the bulk of any suture line is in the knots, rather than the lengths of suture material between knots, this technique may be less susceptible to suture abscess or suture spitting than others.
Nonabsorbable monofilament suture may also be used, in which case suture removal may be performed approximately 2 weeks postoperatively.
The pucker effect of this closure resolves rapidly in atrophic skin, though it can persist in other areas; patients should realize that some degree of residual puckering toward the center of the wound is to be expected.
This approach provides less wound eversion than vertically oriented approaches such as the set-back dermal or buried vertical mattress sutures. Therefore, consideration should be given to adding additional superficially placed everting sutures, such as the vertical mattress suture, in order to mitigate this problem. Still, since this approach is generally adopted when the surgeon has accepted that the cosmetic outcome may be less than ideal, it may be reasonable to use this approach as a solitary closure.