From ideal to adequate: Revisiting the suture length–wound length ratio in emergency midline laparotomy closure

A suture length to wound length (SL:WL) ratio of ≥4:1 when closing laparotomy incisions seems to help prevent incisional hernias. However, this practice is often not followed. Our prospective study of 140 patients assessed emergency midline laparotomy wound closure by surgical residents; and compared wound outcomes between those with and without a SL:WL ratio of ≥4:1. The latter was achieved in only one patient. While the incidence of wound dehiscence and of incisional hernia at six months was similar in those with a SL:WL ratio of <3 and ≥3 (<i>p</i> = 0.73 and <i>p</i> = 0.32 respectively), it was significantly higher in those with a SL:WL ratio <2.5 than ≥2.5 (<i>p</i> = 0.005 and <i>p</i> = 0.02 respectively). Even if an ideal SL:WL ratio of ≥4:1 cannot be achieved, a SL:WL ratio of ≥3 would be adequate to prevent surgeon-related wound dehiscence and incisional hernias.