Some visible pleating, particularly on the side with excess, is expected in the immediate postoperative period. In most areas, this will resolve with time as the wound heals.
As with all running techniques, the integrity of the entire suture line rests on two knots, and 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 and wound edge length equalization.
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.
As with any suturing technique, knowledge of the relevant anatomy is critical. When placing running pleated 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.
Similarly, 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.