Six-fold suture : wound length ratio for abdominal closure

Midline laparotomy incision is generally closed as a continuous single laye r with monofilament suture. To achieve safe abdominal closure, it is advise d to have a suture:wound length (SL:WL) ratio of more than 4:1. The importa nce of a high SL:WL ratio led us to standardise a safe abdominal closure te chnique. We calculated the subsequent SL:WL ratio and support our finding w ith a mathematical model. Between March 1996 and February 1997, 100 consecutive patients undergoing e lective or emergency laparotomy through a midline incision were entered int o this prospective study. The wounds were closed with a single layer contin uous suture to approximate the abdominal muscles. Suture and wound lengths were recorded. Patients were followed for one year. Five patients developed incisional hernia at 12 months postoperatively. The re was no burst abdomen. The mean SL:WL ratio: was 6.2:1. A mathematical mo del confirms that a SL:WL ratio of 6:1 should be achieved with this suture technique. We recommend an optimal SL:WL ratio: greater than or equivalent to 6:1 to a chieve safe closure of midline laparotomy incision.