Depending on the degree of tension and the thickness and resilience of the dermis, this technique may lead to some epidermal and dermal damage that may not be desirable. Therefore, care should be taken to use this approach only when absolutely needed. The risk of necrosis, while mitigated by the fact that these sutures are only left in place temporarily, is still a possibility, and even in the absence of true tissue necrosis the trauma of crush injury to the delicate dermal vasculature is a possible risk as well.
Although this approach is designed to take advantage of mechanical tissue creep, it is not a dynamic suture technique, since the ends of the suture material are tied together. Therefore, the suture material may be pulled with a skin hook every few minutes to take advantage of tissue creep but are not secured in the new position, since the suture was tied after its initial placement.
As with any suturing technique, knowledge of the relevant anatomy is critical and it is important to recall that the structures deep to the epidermis may be compromised by the passage of the needle and suture material. For example, the needle may pierce a vessel leading to increased bleeding.
Given the possible problems associated with this approach, a double or pulley buried suture is preferable for effecting closure in high-tension areas when feasible. This technique remains a useful adjunct, however, in cases of extreme tension where mechanical tissue creep may be relied on to add laxity to a very tight closure.