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 failing to follow the curvature of the needle. This problem may be particularly pronounced with the shorthand vertical mattress suture in novice hands, as the initial, superficially placed throw of suture material may be placed too superficially, resulting in suture material tear-through.
Since the second, deeper loop of suture is placed blindly when using the shorthand technique, care should be taken when working in areas with underlying vessels or nerves which could be pierced or strangulated by the deeper loop of suture. This is less of a problem when using the standard vertical mattress technique, since the deep loop is placed first, permitting full visualization of the underlying structures.
The shorthand vertical mattress technique does not typically permit the same degree of wound-edge apposition as can be accomplished with other transepidermal sutures, since the everting effect of the suture technique may even be associated with a small degree of gaping at the center of the vertical mattress suture.
As with the standard vertical mattress suture, suture removal with this technique may be more involved than with simple interrupted sutures, particularly if sutures are left in situ for an extended period of time and some of the suture material has been overgrown by the healing epidermis.
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 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.