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As noted previously, this is an infrequently utilized approach, and is best for closing areas under mild to moderate tension when other running approaches are not feasible. Since knots are tied only at the beginning and the end of the entire line of sutures, this technique is faster than utilizing standard interrupted percutaneous set-back dermal sutures, though this benefit must be weighed against the increased risk of suture line compromise with this approach.
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It is critical to focus on outstanding knot security, since the entire suture line is held in place by the knots at the beginning and end of the set of suture throws. Adding an additional tacking knot when utilizing this approach is an option as well. It may provide additional knot security. Alternatively, one could consider placing an additional knot or leaving a longer suture tail.
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Although it requires utilizing a backhand technique, this approach may be easier than other running buried techniques, since the suture pierces the epidermis and dermis at a 90 degree angle there is no need to change planes or guarantee that the suture exit point is precisely at the inside edge of the lower dermis.
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This approach may also be used in wounds under modest tension where extensive undermining is not possible; since the undersurface of the dermis does not need to be visualized to effectively place the sutures, the throws can be essentially placed blindly.
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This technique may be conceptualized as a largely buried alternative to the simple running closure, since both approaches do not require wide undermining or an easily reflected wound edge and both approaches may be utilized in areas under modest tension.
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An important theoretical advantage of this approach over other running percutaneous approaches is that no suture material is left between the wound edges. Since even absorbable suture material may represent a physical impediment to wound healing, this is an important benefit that this approach shares with the percutaneous and standard set-back dermal suture techniques.
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Another theoretical benefit of the running approach is that there is less suture material left in situ, since the bulk of retained absorbable suture material is in the knots; as there are knots only at the beginning and end of the row of sutures, this technique theoretically decreases the risk of suture spitting and suture abscess formation. Still, the standard running set-back approach leaves suture material deep to the undersurface of the dermis, and therefore the risk of suture spitting and suture abscess formation is negligible.