How tight should tension sutures be tied? A controlled clinical trial.
Rosenberg I L, Brennan T G, Giles G R·The British journal of surgery
In a prospective randomized trial there was no advantage in tying tension sutures flush with the wound; by tying them loosely (over three fingers of the assistant's hand) there was less wound pain and less cutting in of the tension suture into the ridge of the wound and along the suture tracks.