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You'll of course need inkscape installed
You'll need an image. .png's work, probably other formats too. It should be as straight as possible. Use a tool like the Gimp to correct rotation if necessary. It should be straight enough so that a line from top/bottom or left/right is straight enough for your purposes.
This assumes that you have a 90 degree routed sample. You'll have to make tweaks but nothing major for something not of that nature.
I am as of the time of this writing us a mix of Inkscape 0.47 and 0.48.
Launch Inkscape and lets get started
Edit ⇒ Preferences
Without this every time you create a new polygon you'll have to keep re-selecting things.
And save it somewhere.
Without this it will be difficult to get polygons to line up predictably.
Create a new layer to store the image.
: I forget how to do this nicely
As a workaround save and close. Open up a text editor and find the layer you just inserted. Make it look something like this:
<g inkscape:groupmode="layer" id="layer2" inkscape:label="background" style="display:inline" sodipodi:insensitive="true"> <image sodipodi:insensitive="true" y="0" x="0" id="image12" height="9295" width="9515" xlink:href="stitch.png" sodipodi:absref="stitch.png" /> </g>
Save and re-open the document. You should now be able to show/hide that image as a layer. I suggest also locking it so that you don't move it around.