This technique is generally used for its pronounced effect on wound eversion. Therefore, while it is appropriate for most skin closures, it should be avoided when either inversion is desired or when exaggerated eversion has already been accomplished with a buried suture.
As with most transepidermal techniques, it is important to enter the epidermis at 90 degrees, allowing the needle to travel slightly laterally away from the wound edge before fully following the curvature of the needle when utilizing this technique. This will allow for maximal wound eversion and accurate wound-edge approximation.
As with the simple interrupted suture, care should be taken to avoid skimming the needle superficially beneath the epidermis. This results from failing to enter the skin at a perpendicular angle and to follow the curvature of the needle.This may result in wound inversion as the tension vector of the shallow bite pulls the wound edges outward and down.
An advantage of this approach is that no suture material traverses the incised wound edge and that the suture similarly does not cross the surface of the wound. While this may be less than desirable when attempting to fine-tune epidermal apposition, it is helpful in minimizing the risk of unsightly track marks.
This technique is sometimes referred to as a far-far, near-near suture, based on its entry and exit points; the needle is first inserted far from the incised wound edge, and then again exits far from the wound edge on the contralateral side. It is then reinserted near the wound edge on the ipsilateral side and exits near the wound edge on the contralateral side.
Note that the second throw is placed superficial to the first, deeper far-far suture, leading to a nested placement of the suture material. This leads to both wound eversion as well as wound-edge approximation.
The Allgöwer technique involves performing a half-buried vertical mattress suture: (1) The needle is passed from the far entrance point to the interior of the wound. (2) A buried vertical mattress bite is then taken on the contralateral side, by entering the underside of the dermis and exiting at the incised wound edge. The needle then passes back to the original side, entering near the incised wound edge so that one-half of the wound is closed with a standard vertical mattress suture and the other is closed with a buried vertical mattress.