Shoelace and honey technique: An innovative and inexpensive method of wound healing

Abstract

Wound closure and wound infection have been a great enemy to orthopaedic surgeons since the beginning of time. Many wound closure technique have been described and controversy exists as a optimal method. Healing by secondary intension used to be commonly employed technique but less popular nowadays. Most wound closure require split skin thickness grafting which increases morbidity and scarring and additional wound at donor site .gradual mechanical dermal apposition technique that is shoelace technique have gained popularity and have shown to be effective in closure of wounds .Shoelace technique for wound closure is widely used in other medico-surgical specialties, this technique is unusual in orthopedics surgery, but the simplicity of the procedure, demanded us to follow to our cases.Honey is most ancient wound dressing biomaterial .Honey is known for its anti-oxidant, anti-bacterial and anti-inflammatory properties which were used for better and faster wound healing. Both the methods combined together make it a magic formula for the wound healing.We have 21 patients presenting to VDGMC, LATUR from a period from May 2020 to December 2023, with difficult primary wound closure were included in the study. The patients underwent the surgical fracture fixation (if any), followed by application of shoelace technique and honey dressing for the patient. An infant feeding tube and skin staples were used for the technique. Patients were followed till the complete wound healing occurred. The average time required for the wound healing using this technique was 3.2 weeks. Once the skin was approximated by dermatotraction, delayed primary suturing was done and regular dressing protocol was followed.Our study showed an excellent wound healing in 20 cases with duration of wound healing less den 3 weeks, which also waived of the need for an extra procedure of skin grafting. 1wound had continuous wound discharge which needed an extra debridement procedure longer duration for closure.The successful out-come observed in these cases, and at a very low cost, allows for its consideration as indicated for situations similar to that presented in this study, especially in patients with poor economic background.