As with other running dermal techniques, this approach leaves a fair amount of absorbable suture material in the dermis. Therefore, foreign-body reactions, suture abscess formation, and infection are possibilities. The entire suture line is secured with a single knot, and since most of the bulk of any suture line is in the knots, rather than the lengths of suture material between knots, this technique may be less susceptible to suture abscess or suture spitting than others.
Utilizing the same holes for exit and entry of the needle is designed to minimize residual skin dimpling, but increases the risk that the suture material will be cut by the needle as it renters the same hole. Since the entire closure rests on the resiliency of a single strand of suture, this risk should not be overlooked. A simple variation of this technique, where the needle is reinserted through a hole just lateral to the exit point, may help mitigate this potential risk.
Skin dimpling is often seen with this approach, particularly since these wounds are often closed under significant tension. This does generally resolve with time, but patients should be warned to expect these changes in the immediate postoperative period.
As with the buried purse-string closure, the pucker effect of this closure resolves rapidly in atrophic skin, though it can persist in other areas; patients should realize that some degree of residual puckering toward the center of the wound is to be expected.
Since the entire closure is held by a single knot, this approach may be associated with a higher rate of wound dehiscence, as knot failure or failure in the suture material at any point leads to an immediate loss of tension on the closure. Given the concern regarding knot breakage, it may be helpful to attempt to better secure the knot. This may be done by paying particularly close attention to knot tying, tying an extra full knot, adding extra throws, or leaving a longer tail that would traditionally be executed.
While arguable better than the fully buried purse-string closure, this approach provides less wound eversion than vertically oriented approaches such as the set-back dermal or buried vertical mattress sutures. Therefore, consideration should be given to adding additional superficially placed everting sutures, such as the vertical mattress suture, in order to mitigate this problem. Still, since this approach is generally adopted when the surgeon has accepted that the cosmetic outcome may be less than ideal, it may be reasonable to use this approach as a solitary closure.