Using Modified Shoelace Technique in Closing Wounds Other than Fasciotomies

Abstract

Background: Shoelace dermatotraction was designed for delayed primary closure of fasciotomies. This technique employed the concept of creeping migration of the skin to achieve wound closure progressively and it's efficacy in treating fasciotomies has been discussed by several studies. Aim and Objectives: The applicability of shoelace dermatotraction in different defects and different locations has not been clarified in the past. For patients not suitable for advanced surgeries or unwilling for major surgeries, the shoelace technique was quite useful to reduce the wound dimension. Delayed primary healing or faster secondary healing could be possible. We extrapolated this technique to wounds other than fasciotomies and presented our experience of classical and modified technique in this study. Materials and Methods: From February 2004 to December 2005, twenty six shoelace dermatotractions were performed on varied locations of nineteen patients. The classical shoelace technique was applied with No. 1 PDS interweaving between the skin staples anchored on the wound edge. Wound approximation was achieved by tightening the sutures. This technique was used in 16 wounds of 13 patients. The modified technique was designed to prevent wound edges inversion occurred during traction and was applied to 10 wounds of 6 patients. Instead of staples, figure-of-eight sutures with 2-0 PDS placed on the edges of the wound was used as the anchor for traction. Two No.1 PDS sutures interweaving these 2-0 sutures were used as shoestrings. Results: The wounds closed with modified technique tend to be an edge-to-edge approximation rather than an inversion. Evenly distributed force advanced the margins and shrank the size of defects effectively. Wounds healed either by delayed primary healing, faster secondary healing, or smaller skin grafts. Defects in front of the bones and joints were difficult to be closed by delayed primary intension with shoelace technique. Conclusion: Modified technique conquers skin inversion and efficiently shrinks the defects, reducing donor site morbidity. This technique is cheap, simple, and employs materials with easy availability.