Six-fold suture:wound length ratio for abdominal closure.

ABSTRACT

Midline laparotomy incision is generally closed as a continuous single layer with monofilament suture. To achieve safe abdominal closure, it is advised to have a suturewound length (SLWL) ratio of more than 41. The importance of a high SLWL ratio led us to standardise a safe abdominal closure technique. We calculated the subsequent SLWL ratio and support our finding with a mathematical model. Between March 1996 and February 1997, 100 consecutive patients undergoing elective or emergency laparotomy through a midline incision were entered into this prospective study. The wounds were closed with a single layer continuous 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. There was no burst abdomen. The mean SLWL ratio was 6.21. A mathematical model confirms that a SLWL ratio of 61 should be achieved with this suture technique. We recommend an optimal SLWL ratio greater than or equivalent to 61 to achieve safe closure of midline laparotomy incision.