This approach is very useful when attempting to recreate a natural crease, especially since traditional everting sutures have a tendency to blunt natural creases. Since the eye is naturally drawn to skin folds and creases, this small change may have a dramatic effect on the ultimate outcome of the repair.
Unlike the traditional horizontal mattress, this technique does not result in significant compression of the underlying vascular plexus, and in fact it results in only modest tension across the wound surface.
A gap remains between the suture material and the incised wound edge, since the inversion of the wound edges causes them to be depressed relative to the surrounding skin. Therefore, track marks are unlikely with this technique.
It is helpful to take the bites of the inverting horizontal mattress suture approximately 5-mm lateral to the incised wound edge, as this leads to a relative lift on the skin lateral to the wound edge, helping to accentuate the desired wound inversion.