This technique is ideal for use in areas where placement of a traditional buried suture is challenging due to limited space, such as the scalp and lower leg. Even using small semicircular needles and with extensive undermining, it may be difficult to insert the body of needle into the undersurface of the dermis in these anatomic locations.
This technique may also be useful when placing an additional suture between two reasonably tightly set sutures, and where full retraction of the wound edge is, therefore, impossible.
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 may preclude full exposure of the undersurface of the undermined dermis.
Finally, this technique may be utilized when a buried suture needs to be placed in an area that has not been undermined; the initial suture placement, entering from the underside of the dermis, can be performed blindly by sliding the needle through the superficial fat and entering from the underside of the dermis.