Surgical wounds are typically closed immediately after an operation using primary closure, where the edges of the incision are brought together with standard sutures or staples. This technique is sufficient for wounds with minimal tension and normal healing capabilities. However, specialized closure methods are required when primary closure is inadequate due to wound size, location, or patient health factors that compromise healing. These methods prevent wound dehiscence, the premature separation of the surgical incision.
Retention Sutures Defined: Tension-Reducing Closure
Retention sutures are a specialized closure designed to provide supplemental support to the primary suture line, making them a type of tension-reducing closure. Their purpose is to distribute mechanical forces across a much wider area, reducing strain on the immediate wound edges and the underlying fascia. They are placed several centimeters away from the main incision and reinforce the initial repair.
These sutures decrease the risk of wound dehiscence. The material used is typically a heavy gauge, non-absorbable suture, such as thick nylon, which provides the necessary tensile strength. By anchoring into deeper layers of tissue, retention sutures ensure the mechanical integrity of the closure while the body heals the wound layers beneath.
Surgical Scenarios Requiring Retention Sutures
The application of retention sutures is reserved for specific surgical situations and for patients at high risk for poor wound healing. They are frequently used in extensive procedures, such as large abdominal closures following a laparotomy, where the incision is long and subjected to high internal pressure from movement or coughing. This is common in general surgery, where abdominal wall integrity is a major concern.
Patient-specific risk factors include obesity, which places increased tension on the incision. Individuals with chronic diseases like diabetes, malnutrition, or those receiving corticosteroid therapy also have compromised healing capacity. In these high-risk patients, retention sutures are used prophylactically to ensure the surgical site remains closed.
Technique and Management
The mechanical difference of a retention suture lies in its full-thickness placement, which distinguishes it from standard superficial skin sutures. The heavy-gauge suture is passed through all layers of the tissue—including the skin, subcutaneous fat, and the underlying fascial layer—and then out the opposite side. This deep anchoring provides the substantial support needed to secure the closure.
To prevent the strong suture material from cutting into the skin, external devices like bolsters or bridges are often used. These devices are placed under the suture loops to distribute the pressure over a larger area, preventing “cheesewiring” or skin necrosis. Retention sutures are typically left in place longer than standard skin sutures, often remaining for 14 to 21 days. This extended timeframe allows the deep fascial layers, which heal slowly, to gain sufficient tensile strength before the mechanical support is removed.