This variation has a disadvantage when compared with the standard running horizontal mattress technique, in that locking each throw means that there is suture material passing over the incision line with every throw. As suture material passing over the center of the wound may be associated with track-like scarring, this disadvantage needs to be weighed carefully against any perceived advantages of this technique.
Moreover, particularly if the suture material is under significant tension, structures deep to the defect may be constricted. This can lead to necrosis due to vascular compromise or even, theoretically, superficial nerve damage. These concerns are more acute with the running locking horizontal mattress suture than with the simple running suture, since the wide arc of the suture material and its horizontal component incorporate more skin and underlying structures, thus increasing the risk of strangulation.
The potential to constrict deeper structures may be used to the surgeon’s advantage in the context of a slowly oozing surgical wound, since this technique may indirectly ligate the culprit vessels. This should only be used in the event that the offending vessel is relatively small, since otherwise there is a significant risk that this indirect ligation will not be sufficiently resilient. Moreover, tying the suture too tightly may increase the risk of developing track marks or superficial necrosis.
This technique may elicit an increased risk of track marks, necrosis, and other complications when compared with techniques that do not entail suture material traversing the scar line, such as buried or subcuticular approaches. Therefore, sutures should be removed as early as possible to minimize these complications, and, as noted previously, consideration should be given to adopting other closure techniques in the event that sutures will not be able to be removed in a timely fashion.