For continuous mass or fascial closure of a midline incision, the length of suture used should be at least four times the length of the wound. Below that ratio, incisional hernia and dehiscence rates rise. Measuring both is simple: note the wound length before closing and the length of suture left over at the end. Small-bite closure naturally achieves a high ratio because each stitch is placed close to the edge and close to the next.
- Measure the wound length before closing the fascia.
- Record the suture used by subtracting the remnant from the total length.
- Aim for a suture length to wound length ratio of at least 4:1.
- Use a slowly absorbable monofilament suture for continuous fascial closure.
Why it matters
The ratio is a cheap audit of closure quality that any theatre team can record.
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