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This technique is best for areas where placement of a traditional running buried suture is challenging due to limited space, such as the scalp and lower leg, though it has been advocated as an approach with broader application.
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This approach may also be used when it is difficult to visualize the undersurface of the dermis, since the needle throws may be placed in an almost blind fashion. The skin is grasped gently to make it taut and the needle is inserted through the undermined space, exiting on the outside of the skin. This may be executed by feel, an approach well suited to the scalp where minimal dermal elasticity precludes full exposure of the undersurface of the undermined dermis.
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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, and may provide additional knot security. Alternatively, one could consider placing an additional knot throw or leaving a longer suture tail when utilizing this approach.
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Like the running percutaneous set-back dermal suture, 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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A 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.