# Revisiting Jenkins’ Rule: Evidence-Based Insights on the Suture-to-Wound Length Ratio and Wound Dehiscence

## TL;DR

This paper reviews evidence on how suture length to wound length ratios affect wound dehiscence, suggesting that the traditional Jenkins' 4:1 rule should be adapted based on surgical context and patient factors.

## Contribution

The study provides evidence-based recommendations for tailoring suture-to-wound length ratios based on surgical tension, patient characteristics, and suture material.

## Key findings

- Jenkins’ 4:1 suture-to-wound length ratio remains a reliable baseline for fascial closure.
- Higher ratios (5:1-6:1) are beneficial in high-tension closures like emergency laparotomies in obese patients.
- Lower ratios (3.5:1-4:1) suffice for low-tension procedures such as laparoscopic port-site closures.

## Abstract

Wound dehiscence is a serious postoperative complication, with fascial closure technique and suture-length to wound-length (SL:WL) ratio being key determinants of wound integrity. Jenkins’ rule, recommending a 4:1 SL:WL ratio, has long guided midline laparotomy closure. Recent evidence suggests that optimal ratios should be tailored to the surgical context, patient factors, and suture material. High-tension closures, such as emergency laparotomies in obese patients, benefit from higher ratios of 5:1-6:1, while elective or low-tension procedures, including laparoscopic port-site closures, may achieve secure outcomes with ratios of 3.5:1-4:1. Modern suture materials, including monofilament, delayed-absorbable, and barbed sutures are combined with fine-bite or short-stitch techniques, enhance fascial approximation, reduce tissue trauma, and allow flexible ratio application. This systematic review of five studies with a combined sample size of 1,431 patients confirms that Jenkins’ 4:1 rule remains a reliable baseline. However, SL:WL ratios should be adapted to wound tension, surgical setting, and patient characteristics. Tailoring suture length to these factors can optimize fascial closure, minimize wound dehiscence, and improve postoperative outcomes, providing a modern, evidence-based refinement of Jenkins’ foundational principle.