Letter to the Editor: Combined oblique and vertical everting running stitch: Redefining the biomechanics of wound closure

Abstract

The combined oblique and vertical everting running suturing (COVER) technique, which uses a combination of oblique and vertical running everting closures, has been proposed as an alternative approach to close the wound in order to offer biomechanical stability with an appropriate biological healing environment. By employing an angled suture orientation with a vertical everting pattern, the COVER technique redistributes tensile forces throughout wound margins, providing a more even stress field, thereby enabling precise apposition of tissues at several anatomic levels. Biologically, this arrangement would induce dilution of local stress while maintaining continual microcirculatory flow, preventing inflammation, and allowing controlled deposition of collagen and epithelialization. Recent studies have reported clinical results that suggest a potential benefit from the COVER technique in terms of healing rates, cosmetic outcome, and complication rates compared with conventional suture techniques. Mechanistic and concept-driven analyses of biomechanical implications, biological outcomes of the COVER configuration, and its applications in wound management under high-tension or reconstructive situations are exemplified.

Keywords: Combined oblique and vertical everting running suturing technique; Wound closure; Mechanobiology; Tension modulation; Microcirculation; Regenerative medicine; Scar remodeling

Core Tip: The combined oblique and vertical everting running suture technique integrates principles of biomechanical force transmission with tissue-level biological responses to promote a dynamic and optimized wound healing process. By redistributing tensile forces along oblique and vertical vectors, this approach effectively reduces localized stress concentration while preserving microvascular perfusion at the wound margins. Such biomechanical optimization supports accurate tissue realignment, enhances healing efficiency, and facilitates favorable scar formation. Collectively, this coordinated strategy provides a mechanistically grounded and clinically adaptable pathway to improve functional and cosmetic outcomes in selected surgical settings.