As a running technique, the integrity of the entire suture line rests on the security of the two anchoring knots. Since this approach is not relied on for tension relief, suture material breakage or knot failure, while undesirable, do not generally lead to catastrophic wound dehiscence. Indeed, the traction across the suture material itself affords a small degree of security which may be sufficient to maintain eversion even in the face of knot breakage.
As with the interrupted vertical mattress approach, this technique does not typically permit the same degree of wound-edge apposition as can be accomplished with other transepidermal sutures, since the everting effect of the suture technique may even be associated with a small degree of gaping at the center of the running vertical mattress suture. In the event that deeper sutures were carefully placed, this may not be a significant drawback, since the wound edges may be well-aligned from the placement of these deeper sutures.
Suture removal with this technique may be more involved than with simple interrupted sutures, particularly if sutures are left in situ for an extended period of time and some of the suture material has been overgrown by the healing epidermis.
As with any suturing technique, knowledge of the relevant anatomy is critical. When placing a vertical mattress suture it is important to recall that the structures deep to the epidermis may be compromised by the passage of the needle and suture material, or that constriction may take place. That said, the vertical orientation of this approach helps minimize this risk.
This technique may elicit an increased risk of track marks, necrosis, and other complications when compared with techniques that do not entail suture material traversing the scar line, such as buried or subcuticular approaches. Therefore, sutures should be removed as early as possible to minimize these complications, and consideration should be given to adopting other closure techniques in the event that sutures will not be able to be removed in a timely fashion.