This technique has two main drawbacks. First, the integrity of the entire suture line rests on the integrity of a single knot. When this technique is used only to fine-tune epidermal approximation, knot failure is unlikely to lead to dehiscence, but if there is significant tension across the wound this may be more problematic. Second, the additional row of simple interrupted sutures used in this technique does little to aid in wound-edge approximation or wound security, while concomitantly increasing the risk of track mark formation. Therefore, unless this approach is being utilized for its hemostatic effects, it may not be the ideal technique in most circumstances.
As with all running techniques, since each loop of the running suture material is designed to hold an equal amount of tension, it follows that areas of the wound under greater tension, such as its central portion, may tend to gape or potentially exist under greater tension leading to an increased risk of track marks.
As with any suturing technique, knowledge of the relevant anatomy is critical. When placing the cross stitch it is important to recall that the structures deep to the epidermis may be compromised by the passage of the needle and suture material. Thus, the needle may pierce a vessel leading to increased bleeding, while a tightly placed suture may lead to necrosis due to vascular compromise or even, theoretically, superficial nerve damage.
This technique may elicit an increased risk of track marks, necrosis, inflammation, 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.