Though it may be conceptualized as a bidirectional, two-depth subcuticular closure, the extra row of sutures in this technique pulls the deep tissues together but also adds only modestly to wound security, as the entire suture line is secured with a single knot. Therefore, it is probably best not used as a solitary closure approach, but rather layered over the top of a deeper suturing technique.
While a central strength of this technique is its entirely intradermal placement, this may also represent one of its greatest drawbacks. This technique results in leaving a very significant quantity of foreign-body material in the dermis and deeper tissues in a continuous fashion. While this may not represent a major problem in areas with a thick dermis such as the back, in other anatomical locations the large quantity of suture that is left in situ may result in concerns regarding infection, foreign-body reaction, and even the potential that the suture material itself could present a physical barrier that would impinge on the ability of the wound to heal appropriately.
The extra row of deep sutures used in this technique raises further concern regarding the possibility of tissue strangulation along the wound margin that could theoretically be associated with tightly placed subcuticular sutures. It, therefore, should be reserved for areas with an outstanding vascular supply, such as the face.
If nonabsorbable suture material is used, removal of long-standing suture entails a theoretical risk that a potential space—albeit a thin and long one—is created on the removal of the suture material. This theoretical risk may be mitigated by utilizing the thinnest possible suture material.