This technique ostensibly provides the benefit of decreased risk of tissue necrosis when compared with the running horizontal mattress technique, since the watershed area at risk for vascular compromise is smaller when the bites are taken at a diagonal than when they are perpendicular to the incision line. That said, in clinical experience, loosely tied running horizontal mattress sutures almost never result in wound necrosis.
This technique does, however, have the advantage of taking very short bites parallel to the incision line, so that if any track marks are left they will be very short and inconspicuous. This approach is therefore well suited to utilizing a rapidly absorbable suture, such as fast-absorbing gut, since there is little risk that a slowly degraded suture will leave track marks.
This technique is frequently used on the face, as it aids with dramatic wound eversion. Generally, if the dermis was closed using the set-back dermal suture, no additional eversion is needed; however, when the buried dermal suture or even the buried vertical mattress suture, are used, occasionally the wound edges do not evert to the desired degree.
This approach also helps minimize cross-hatched railroad track marks, since the suture material does not cross over the incised wound edge. Similarly, this technique can sometimes yield a neater immediate postoperative appearance, as even if bite sizes are not uniform this is not apparent to the observer, as only the portions of suture material parallel to the incision line are visible.