[Closure of midline incisions. A lot of small, same-size stitches in the aponeurosis improve wound healing]

The most important risk factor for the development of wound dehiscence and incisional hernia is the suture technique that is totally in the hands of the surgeon. A continuous suture line in one layer with a monofilament material should close midline incisions. Self-locking knots should be used for the anchor knots. The length of the suture used must be at least four times the length of the wound. The only way to ascertain a suture length to wound length ratio of at least four is to measure and document the ratio at every laparotomy. An adequate ratio should be achieved by placing many stitches into the aponeurosis. High tension on the suture should be avoided.