Retention stitches- innovative & easily replicable method of wound closure in knee arthroplasty in obese patients

Knee joint arthroplasty is a commonly performed procedure. However, number of obese patients undergoing total knee arthroplasty is on a rise. In such cases, post closure using routine techniques, there have been an increasing number of cases of wound dehiscence and complications like persistent discharge and delayed healing. To overcome this problem, the author has come up with an innovative technique in closure.

Before starting the closure of the subcutaneous, subcuticular and skin layers, from one end, far stitch is taken using Ethilon number 1 suture loaded in a straight needle. Using the same needle, a far bite is taken on the opposite end. Using a small piece of infant feeding tube in the support, closure is done in the vertical mattress fashion. The two ends of sutures are tied with another small piece of infant feeding tube in between. On tightening the sutures, the layers can be approximated easily, relying on these outer sutures. The retention stitches can be taken from proximal to distal or distal to proximal at even gap to provide a uniform compression and prevent formation of dog ears. The use of infant feeding tube as intermediary structure around the two suture threads helps in two ways,

1. Avoids cut-through and sinkage of stitches into the deeper layers.

2. Makes the process of closure under force less traumatic to the skin and superficial layers of skin.

27 patients, who were obese, were included in the study and operated at Orthopaedic Arthroscopic Knee and Shoulder clinic. The patients were evaluated pre operatively clinically and planned for retention stitches for closure. Same technique was followed for closure in all the patients. Suture removal was done at 2 weeks and patients were followed up for a period of 6 months for any complications.

In 27 patients undergoing retention stitches post total knee arthroplasty, patients were followed up for a mean period of 14 months, with minimum being 6 months and maximum being 5 years.

Patients showed no complications such as wound dehiscence, discharge, localised skin necrosis or cut-through of stitches.

The authors concluded that - retention stitches in knee arthroplasty is an innovative, ideal, yet easily replicable method of wound closure in obese patients, especially with BMI>30 (Obesity grade 1 or more). Patients undergo better and uneventful wound healing, which is of paramount importance in a surgery like this. In all these patients, the rehabilitation post surgery is also similar to the other patients, hence not affecting the outcome.

Further reading:

Retention Stitches: A Concept of Wound Closure of Knee Arthroplasty in Obese Patients

Amyn M. Rajani et al

Indian Journal of Orthopaedics (2022) 56:1048–1052

https://doi.org/10.1007/s43465-021-00596-y