SHOELACE TECHNIQUE FOR DELAYED PRIMARY CLOSURE OF FASCIOTOMIES

Performing a timely fasciotomy for compartment syndrome prevents ische mic injury to muscles and nerves, Fasciotomy entails incision of the o verlying skin and investing fascia of the compartment, relieving press ure and enhancing tissue perfusion. Delayed primary closure is ideal, but because of skin edge retraction, the open wound must either heal s econdarily or be closed with a split-thickness skin graft. The shoelac e technique involves running a silastic vessel loop through skin stapl es placed at the skin edge along the initial fasciotomy incision. Dail y tightening of the shoelace permits gradual reapproximation of the sk in edges while compartment edema resolves. Closure using a simple sutu re or Steri-strip (3M Surgical Products, St. Paul, Minnesota) is then possible after 5 to 10 days. The shoelace technique allows for gradual primary closure of open fasciotomy. wounds, thereby avoiding the morb idity and cost associated with skin graft or secondary closure.