The vessel loop shoelace technique for closure of fasciotomy wounds

Compartment syndrome of the extremity may occur after severe trauma seconda ry to fractures, vascular ischemia, crush, or electrical injury. Treatment consists of expedient fasciotomy to avoid permanent injury to muscles or ne rves. Management of the wounds postoperatively has consisted traditionally of primary closure, healing by secondary intention, or split-thickness skin grafting to cover defects. The fasciotomy wound may remain substantial sec ondary to soft-tissue swelling and edema. The authors present an alternativ e protocol for fasciotomy wound management, consisting of gradual closure w ith progressive tension using vessel loops. The vessel loops are placed int raoperatively during the compartment release and are attached to the wound margins using standard skin staples. The loops are tightened progressively postoperatively during routine dressing changes, resulting in closure of th e wound within 2 weeks. The advantages over split-thickness grafting includ e avoidance of donor morbidity and better cosmesis. Sporadic case reports u sing similar techniques have been published in the orthopedic literature wi th comparable results. The current series includes 37 patients, ages 9 to 4 8 years, who were treated for open fasciotomy. There were 11 upper extremit y and 26 lower extremity wounds treated, all of which were closed within 3 weeks.