Effect of Stitch Length on Wound Complications After Closure of Midline Incisions A Randomized Controlled Trial

Hypothesis: In midline incisions closed with a single-layer running suture, the rate of wound complications is lower when a suture length to wound length ratio of at least 4 is accomplished with a short stitch length rather than with a long one. Design: Prospective randomized controlled trial. Setting: Surgical department. Patients: Patients operated on through a midline incision. Intervention: Wound closure with a short stitch length (ie, placing stitches <10 mm from the wound edge) or a long stitch length. Main Outcome Measures: Wound dehiscence, surgical site infection, and incisional hernia. Results: In all, 737 patients were randomized: 381 were allocated to a long stitch length and 356, to a short stitch length. Wound dehiscence occurred in 1 patient whose wound was closed with a long stitch length. Surgical site infection occurred in 35 of 343 patients (10.2%) in the long stitch group and in 17 of 326 (5.2%) in the short stitch group (P=.02). Incisional hernia was present in 49 of 272 patients (18.0%) in the long stitch group and in 14 of 250 (5.6%) in the short stitch group (P<.001). In multivariate analysis, a long stitch length was an independent risk factor for both surgical site infection and incisional hernia. Conclusion: In midline incisions closed with a running suture and having a suture length to wound length ratio of at least 4, current recommendations of placing stitches at least 10 mm from the wound edge should be changed to avoid patient suffering and costly wound complications.