Occasionally, it is necessary to use a retention or through-and-through suture. This is especially true in debilitated patients who have risk factors for dehiscence such as advanced age, malnutrition, malignancy, or contaminated wounds. The most frequent use of retention sutures, however, is for a secondary reclosure of a postoperative evisceration or full-thickness disruption of the abdominal wall. Through-and-through #2 nonabsorbable sutures on very large needles may be placed through all layers of the abdominal wall as a simple suture or as a far-near/near-far stitch (Figure 27). In this technique, the fascia is grasped with Kocher clamps and a metal ribbon retractor is used to protect the viscera. The surgeon places the first suture full thickness through the far side abdominal wall. The needle is then brought through the near linea alba or fascia about 1 cm back from the cut edge with the path going from peritoneal surface toward the skin (Figure 23). The suture then crosses the midline to penetrate the far side fascia in a superficial to deep manner (Figure 24). The free intraperitoneal suture is then continued full thickness through the near abdominal wall (Figure 25). As seen in cross section (Figure 26), it is important that the abdominal wall full-thickness bites taken at the beginning and end of this placement are not positioned so laterally as to include the epigastric vessels within the rectus abdominis muscles. Compression of these vessels when the suture is tied may lead to abdominal wall necrosis. Additionally, the intraperitoneal exposure of this suture should be small so as to minimize the possibility of a loop of intestine becoming entrapped when the retention is tied. In general, the entrance and exit sites are approximately 1.5 or 2 inches back from the cut edge of the skin (Figure 27). Many surgeons use retention suture bolsters or simple 2-inch sections of sterilized red rubber tubing in order to minimize the cutting of the suture into the skin during the inevitable postoperative swelling. Because of this swelling, the retention sutures should be tied loosely rather than snugly such that the surgeon can still pass a finger between the retention suture and the skin of the abdominal wall.