The need to bevel the wound edges means that this technique requires a small degree of preplanning. The bevel may, however, be useful for other techniques as well, as it may help with wound-edge apposition in general, though there is also the theoretical risk of contracture leading to a small separation between the wound edges. If the butterfly suture is utilized without beveling the wound edges, a small amount of dermis may overhang in the incised wound edges, preventing wound-edge apposition. In this event, surgical scissors or a blade may be used to trim back the overhanging dermis to permit the epidermal wound edges to come together unimpeded.
Some authors have raised concerns regarding possible wound-edge necrosis associated with horizontally oriented suture placement. Advocates of this approach report that wound-edge necrosis has not been seen as a complication, and indeed the only time that necrosis seems to be an issue is with superficially placed horizontal mattress sutures, rather than with their buried counterparts. This is likely due to a constrictive effect on the incised wound edge, which is not typically seen with buried sutures.
While the suture loops may be relatively close together, especially under areas of marked tension, the loops themselves should not overlap, as this has the potential to compress the wound edges together leading to central bunching of the wound edges.
Given the marked eversion associated with this technique, patients may be left with a small ridge in the immediate postoperative period. While this is desirable, it is also important to warn patients of this outcome; explaining that the technique is akin to placing a subcutaneous splint may help the patient develop reasonable and realistic expectations and reduce anxiety regarding the immediate postoperative appearance of the wound.