• L A Israelsson, T Jonsson, and A Knutsson.
• Department of Surgery, Sundsvall County Hospital, Sweden.
• Eur J Surg. 1996 Aug 1;162(8):605-9.

ObjectiveTo study the influence of suture technique on healing of midline laparotomy wounds.DesignProspective clinical study.SettingCounty hospital, Sweden.Subjects467 patients who underwent midline laparotomy between September 1991 and June 1993.InterventionsWounds were sutured by a continuous technique. The suture length: wound length ratio, the stitch length, and the interval between stitches were recorded together with the body mass index and operative variables.Main Outcome MeasuresIncidence of postoperative wound infection and of incisional hernia at 12 months.ResultsWound infection developed in 25 of 150 (17%) wounds if the stitch length was 5 cm or more and in 21 of 307 (7%) if it was shorter than 5 cm (p < 0.01). Overweight patients were sutured with a longer stitch and there was a high rate of infection among these patients: 20/253 (14%) compared with 30/211 (8%) (p < 0.05). In a multivariate analysis stitch length 5 cm or more and degree of wound contamination were independent risk factors for wound infection. Incisional hernias developed in 42 of 368 patients (11%). In a multivariate analysis suture length: wound length ratio less than 4, overweight, and wound infection were independent risk factors.ConclusionSuture technique affects both early and late wound complications. The rate of incisional hernia is lower if the suture length: wound length ratio is 4 or more. However, a high ratio should not be achieved by suturing with a stitch length of 5 cm or more as this is associated with an increase in the rate of wound infection.

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