The central drawback of this approach is that, as with all running techniques, the integrity of the entire suture line rests on two knots. Moreover, suture material compromise at any point may lead to a complete loss of the integrity of the line of sutures. Since this technique is designed for low-tension environments, however, even in the face of suture material breakage the remaining throws of suture may permit some residual epidermal approximation.
Since all loops of suture are placed in succession, this technique does not permit the same degree of fine-tuning of the epidermal approximation as a simple interrupted suture. This must be weighed against the benefit of the increased speed of placement of a line of running sutures versus interrupted suture placement, where each throw is secured with its own set of three or more knots.
Moreover, since each loop of the running suture material is designed to hold an equal amount of tension, it follows that areas of the wound under greater tension, such as its central portion, may tend to gape or potentially exist under greater tension leading to an increased risk of track marks.
With any suturing technique, knowledge of the relevant anatomy is critical. When placing simple running sutures 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.
Similarly, particularly if the knot is tied relatively tightly, structures deep to the defect may be constricted. This can lead to necrosis due to vascular compromise or even, theoretically, superficial nerve damage; again, this risk may be mitigated by maintaining some laxity in the suture throws.
This technique may elicit an increased risk of track marks, necrosis, inflammation, 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.