Unlike many other running techniques, this approach relies on the suture material traversing the wound at a 45-degree angle in order to permit the individual vertical mattress components to remain perpendicular to the incised wound edge and simultaneously allow the running nature of this technique to progress along the length of the wound. While this results in a neat postoperative appearance, with visible suture material sitting perpendicular to the incised wound edge, it also means that the tension vector of the sutures is at an angle to the underlying tension across the incised wound edge.
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 weaving of the suture material itself affords a small degree of security that may be sufficient to maintain eversion even in the face of knot breakage.
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.