The Lacing Dermatotraction Suturing Technique

Abstract

Introduction: Hailing from a tertiary government-aided center, infected surgical wounds varying from diabetic foot and necrotizing fasciitis to surgical site infection are by far the most common cluster of cases encountered in our practice. Due to an overall lack of patient education on wounds, most of these patients present late, necessitating extensive debridement and tissue loss.
 Aim and Objective: To describe the lacing dermatotraction technique and to study its application in aiding early secondary closure of infected surgical wounds.
 Material and Methods: An interventional Study was conducted at VICTORIA Hospital, Bangalore, from February 2020 to October 2021. Fifty-four patients with Infected wounds were debrided until healthy margins were obtained, followed by applying the shoelace tension lacing suture. This consisted of an infant feeding tube running under loops of prolene fixed 1 cm away from the edge of the wound. One end of the IFT is anchored to the skin, and the other is held in position with single throws of no-1 silk suture, which can be loosened at the next sitting for adequate wound exposure, which aids in better debridement. The tension suture is again tightened to attain the maximal possible wound approximation. Thus, constant traction on the skin edges creates progressive closure until secondary closure is achieved.
 Results: 54 Patients were enrolled, consisting of 8 amputation stump infections, 11 diabetic foot, 14 disarticulations, five bed sore, 12 fasciotomies, three mastectomy flap necrosis, and one traumatic avulsion. There were 38 males and 16 females, with a mean age of 53.4 years. The mean duration of the wound at presentation was 17 days, and they were subjected to an average of 11 days of debridement. Mean wound dimensions - length= 11.02cm, breadth=4.86cm and area = 53.55 cm2. On applying the lacing, the wounds were debrided for an average of 8.85 days with 2.9 tightening. Secondary closure was achieved in 45 (83.33%) patients,.
 Conclusion: The lacing technique is inexpensive and safe to achieve early secondary closure of infected wounds. It avoids the need for skin grafts, reducing the need for anesthesia, hospital expenditure, and duration of hospital stay of patients.