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

Table 1 Comparative analysis between the combined oblique and vertical everting running suturing technique and conventional suturing methods

Ref.	Suturing technique	Mechanical and tensile characteristics	Tissue repair and healing dynamics	Scar morphology and aesthetic outcome	Biological response and perfusion regulation
Chen et al[15], 2023	Simple interrupted suture	Tension concentrated between suture points; overall stress remains high with localized traction	Slower healing; prolonged inflammatory phase	Wider scar; occasional edge depression or fibrotic thickening	Local perfusion limited; mild ischemic tendency
Patil et al[16], 2025	Vertical mattress suture	Dual-depth tension distribution; effective stress dispersion across wound edges	Faster healing with superior tissue adhesion and integration	Flat, inconspicuous scars with high visual conformity	Reduced tension improves perfusion and regeneration
Liu et al[17], 2022	Horizontal mattress suture	Even lateral stress distribution; good resistance to distraction but limited deep coaptation	Stable but moderate healing rate	Fine scar with occasional superficial indentation	Superficial perfusion improved; deep microcirculation partially restored
Li et al[22], 2023	Subcuticular continuous suture	Longitudinal tension transmission reduces dermal stress concentration	Rapid healing with minimal inflammation	Fine, flat scar with minimal chromatic variation	Dermal and subdermal perfusion markedly enhanced; improved oxygenation
Liu et al[3], 2021	Buried dermal suture	Superficial dermal tension predominates; limited eversion of wound edges	Moderate healing; mild early delay under tension	Smooth scar; occasional mild depression or discoloration	Limited microvascular improvement; mild compression of dermal circulation
Su et al[18], 2023	Barbed suture technique	Automatic tension redistribution along incision; knotless design reduces localized stress	Rapid healing with minimal mechanical load	Narrow, well-integrated scar; occasional minor extrusion risk	Distributed stress supports microcirculation, though overtightening may restrict flow
Sadiq et al[1], 2025	COVER suturing technique	Dual-vector (vertical and oblique) tension forming an “inverted-trapezoid” stress field; uniform traction prevents edge collapse	Significantly accelerated healing; minimal inflammation; no delayed closure observed	Thin, smooth, and chromatically consistent scar	Reduced tension enhances dermal microcirculation and oxygenation, promoting angiogenesis and epithelial reconstruction

COVER: Combined oblique and vertical everting running technique.