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

Written By : Dr Supreeth D R |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2022-07-20T20:00:15+05:30 | Updated On 20 July 2022 8:00 PM IST

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.

MBBS, Dip. Ortho, DNB ortho, MNAMS

Dr Supreeth D R (MBBS, Dip. Ortho, DNB ortho, MNAMS) is a practicing orthopedician with interest in medical research and publishing articles. He completed MBBS from mysore medical college, dip ortho from Trivandrum medical college and sec. DNB from Manipal Hospital, Bengaluru. He has expirence of 7years in the field of orthopedics. He has presented scientific papers & posters in various state, national and international conferences. His interest in writing articles lead the way to join medical dialogues. He can be contacted at editorial@medicaldialogues.in.

Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751