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

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 suture:wound length (SL:WL) ratio of more than 4:1. The importance of a high SL:WL ratio led us to standardise a safe abdominal closure technique. We calculated the subsequent SL:WL 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 SL:WL ratio: was 6.2:1. A mathematical model 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 achieve safe closure of midline laparotomy incision.