Since the dermal portion of the suture is executed with the same suture as the vertical mattress portion, if suture removal occurs too early there is a risk of dehiscence, since no residual absorbable suture material is left in the wound. Similarly, if sutures are left in place for too long, there is a high chance of leaving residual track marks.
As the dermal portion of the suture is performed, it may be challenging to visualize the deep portion of the wound adequately, making placement of the deeper portion of the suture more challenging.
When removing sutures, a greater degree of force may need to be applied to remove the full length of the suture material, since the single length of suture has performed multiple loops in both the dermis and epidermis. Suture material breakage is therefore a possibility, and care should be taken to apply constant gentle traction.
With any suturing technique, knowledge of the relevant anatomy is critical. When placing this suture it is important to recall that the structures deep to the epidermis may be compromised by the passage of the needle and suture material, or that constriction may take place. That said, the vertical orientation of this approach helps minimize this risk.
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.