A continuous fascial closure should use a suture length at least four times the wound length. Measure the wound and the suture used, and record both. A ratio below 4:1 means bites are too wide or too few, and is a recognised risk factor for incisional hernia.
Small-bite technique — fascia only, about 5 mm from the edge and 5 mm apart, with a slowly absorbable monofilament — usually produces a ratio well above 4:1 without extra effort.
- Measure wound length and suture used, and record the ratio in the operation note
- Aim for a suture-to-wound length ratio of at least 4:1
- Take fascia only, avoiding fat and muscle in the bite
- Use a slowly absorbable monofilament for continuous closure
Why it matters
Turns closure technique from habit into something a unit can audit.
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