We enjoyed the article by Millbourn et al1 published in the November 2009 issue of the Archives. This study is the first to investigate the role of stitch length—or bite size—in conjunction with suture length to wound length (SL:WL) ratio in a randomized controlled setting. A long stitch length and an SL:WL ratio below 4 were found to be independent risk factors of incisional hernia formation after a follow-up of 12 months. In an experimental study, tissue breaking strength was significantly higher if small bites were used compared with large bites, which could explain the higher incidence of incisional hernia in the long stitch group.2
Harlaar JJ, van Ramshorst GH, Jeekel H, Lange JF. Effect of Stitch Length on Wound Complications. Arch Surg. 2010;145(6):599. doi:https://doi.org/10.1001/archsurg.2010.78
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