Comparison of shoelace technique versus conventional secondary suturing for delayed closure of limited fasciotomy wounds.

Abstract

Acute compartment syndrome (ACS) is a limb-threatening surgical emergency requiring prompt fasciotomy. However, closure of fasciotomy wounds remains challenging and may lead to prolonged healing, increased complications, and higher healthcare costs. This study aimed to compare the clinical effectiveness of the shoelace technique with conventional delayed secondary suturing for fasciotomy wound closure. A prospective comparative study was conducted over 18 months, including 60 patients undergoing fasciotomy for ACS. Patients were equally divided into two groups: shoelace technique (n = 30) and conventional delayed secondary suturing (n = 30). The shoelace group underwent gradual wound approximation with serial tightening every 48-72 h. Primary outcomes included time to wound closure, duration of hospital stay, and treatment cost. Secondary outcomes included postoperative wound complications and functional and cosmetic outcomes. The median time to wound closure was significantly shorter in the shoelace group (8 days; IQR 7-9) compared to the conventional group (14 days; IQR 12-16) (p < 0.001). The shoelace technique was associated with reduced hospital stay and lower treatment costs. Additionally, fewer wound-related complications were observed, along with favorable functional and cosmetic outcomes. The shoelace technique is a safe and cost-effective method for fasciotomy wound closure, associated with faster wound closure and reduced hospital stay compared to conventional secondary suturing. It facilitates faster healing, reduces hospitalization, and lowers complication rates compared to conventional secondary suturing.