Suture length to wound length ratio and healing of midline laparotomy incisions

The effect of suture length to wound length ratio on the healing of midline laparotomy wounds closed with a continuous suture was evaluated in a prospective clinical trial. All patients undergoing abdominal procedures through a midline incision were included except those with an incisional hernia after previous midline operation. The total incidence of wound infection was 36 of 454 patients (7.9 per cent) and wound dehiscence requiring reoperation occurred in three patients (0.7 per cent). Incisional hernia was found in 18.7 per cent of 363 patients alive 12 months after surgery. Multivariate analysis identified the suture length to wound length ratio, age and major wound infection as independent risk factors for the development of hernia, which occurred in 9.0 per cent of patients when the suture length to wound length ratio was > or = 4 and in 23.7 per cent (P = 0.001) when it was < 4. The suture length to wound length ratio is an important parameter for healing of midline incisions closed with a continuous suture technique. The incidence of incisional hernia is lower when such wounds are sutured with a ratio > or = 4.