Shoelace Technique Research Articles

CONTINUOUS DERMIC TRACTION WITH VESSEL-LOOP SHOELACE TECHNIQUE FOR ABDOMINAL WALL DEHISCENCE

Abstract Background The aim of this case is to highlight the importance of strict selection criteria and patient optimization for enhancing outcomes in complex abdominal wall surgery. Methods A fifty-five year-old woman, with a history of diabetes, hypertension, sigmoidectomy and grade IV obesity (BMI 42.8 kg/m2), was counseled for a midline hernia repair (M2–M4, W3). A posterior separation of components with PVDF and PP mesh placement in the retromuscular space was conducted. In the immediate postoperative period, the patient developed respiratory failure, due to abdominal compartment syndrome requiring emergent surgery with mesh removal and an open abdomen treated with Abthera® negative pressure therapy (NPT). After two months in the ICU and NPT without aponeurotic retention, the patient was transferred to our center for definitive treatment. Results The patient arrived with complete abdominal viscera exposure. While a nutritional and respiratory optimization was performed, continuous and progressive dermic traction using a vessel-loop shoelace technique and NPT were applied in order to achieve a progressive abdominal wound closure. Finally, when the skin was sufficient, a new surgery was planned to cover the exposed bowels, where only the cutaneous and subcutaneous planes could be closed. A small dehiscence in the M3 region was treated with skin grafting from the thigh. The patient has since returned home with restored quality of life. Conclusion Inadequate preoperative selection or optimization can lead to life-threatening consequences for the patient. We should promote intensive nutritional education and firmly avoid performing complex abdominal wall procedures in obese patients.

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

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.

Efficacy of the shoelace technique for extremity fasciotomy wounds due to compartment syndrome

BackgroundThe shoelace technique for compartment syndrome allows application of sustained tightening tension to an entire wound and intermittent tightening of the shoelace without requiring its replacement or anesthesia. We retrospectively evaluated the usefulness of the shoelace technique in the management of extremity fasciotomy wounds before and after its introduction in our institution.MethodsWe targeted 25 patients who were diagnosed as having compartment syndrome and underwent extremity fasciotomy at our hospital from April 2012 to December 2021. The N group, comprising 12 patients treated without the shoelace technique, and the S group, comprising 13 patients treated with the shoelace technique, were compared retrospectively for each outcome.ResultsThere were no significant differences between the two groups in patient background. Compared with the N group patients, all of the S group patients avoided skin grafting (S group: n = 0, 0%; N group: n = 6, 50.0%; p < 0.01). However, there was no significant difference in the number of days to final wound closure (S group: 39.5 [IQR 24.3–58.0] days; N group: 24.0 [IQR 18.5–31.0] days, p = 0.06).ConclusionsWe considered the shoelace technique to be a useful wound closure method for fasciotomy wounds caused by compartment syndrome because it can significantly reduce the need for skin grafting and tends to shorten the wound closure period.

902 Systematic Review of Suturing Dermatotraction Techniques in Closing Fasciotomy Wounds

Abstract Aim A surgical patient post fasciotomy presents a challenge to restore cover of the muscle groups. The use of the suturing dermatotraction techniques presents a cheap and easy means of native cover. This systematic review of case series and case controls explored the trend of this technique including duration to delayed primary wound closure, complications and failure rates. Method A literature review was conducted on Medline, Embase and CINAHL yielding a combined total of 820 articles between 1946 and 18 June 2022. Human studies with suturing dermatotraction techniques were included. Twenty-one (21) studies reviewed met the criteria. Results The basic anatomy of the dermatotraction technique involves: An anchor point on the skin; A material for traction and a suture pattern. The Shoelace technique was the predominant suture pattern, with staples as skin anchor material and silastic vessel loops as traction sling used by 9 studies. Modifications of this method included use of intradermal prolene sutures and pediatric catheters. The shortest duration to skin apposition was 2 days and 113 days longest, with most mean closure rates at 7 days. This shoelace technique had fewer or no complications. Data showed superficial and early complications were more likely than deep or delayed complications. NPWT and skin graft salvaged few failed closures in 2 studies. Conclusions Most fasciotomy wounds closed with suturing techniques can expect to close within 7 days, with minimal complications. There are varying practices of traction rates, and this may account for the wide range to delayed primary closure.

Arthroscopic Meniscus Ramp Repair: The Shoelace Technique

Background: A “ramp lesion” is described as an injury involving the peripheral attachment of the posterior horn of the medial meniscus. Ramp lesions are associated with increased loads on anterior cruciate ligament and leads to rotatory instability of knee. During anterior cruciate ligament reconstruction, failure to identify and treat ramp lesion leads to increased forces on the reconstructed graft and residual instability which ultimately increases chances for graft failure. It is important to identify the ramp lesions by looking at the posterior compartment and repair ramp lesion. Ramp lesions are still a challenge to treat due to misdiagnosis and long learning curve of current techniques. In this technique, we are presenting margin convergence shoelace technique to repair a large ramp lesion. Indications: Isolated ramp lesions or ramp lesions associated with other ligamentous injuries. Technique Description: Through standard anteromedial and anterolateral portals, diagnostic arthroscopy is done. Using Gillquist maneuver, posteromedial compartment is visualized to look for ramp lesion. Probing is done with 18-gauge spinal needle from posteromedial aspect of knee to look for hidden lesions and extent of tear. We use 2 additional portals, low and high posteromedial portals for ramp repair. Visualizing from anterolateral portal entry is made in the posteromedial compartment; low posteromedial portal is created at the level of meniscus; 8-mm passport cannula is inserted and used as working portal; and then, high posteromedial portal is created and used as viewing portal. Visualizing through high posteromedial portal rasping of ramp lesion is done. Now with knee scorpion loaded with 2-0 fiber wire, bites are taken along posterior margin of meniscus and capsular portion of tear edges alternatively in shoelace manner from lateral to medial. Finally, compression and knot tying are done and secured with multiple half hitches. Results: Surgical repair of ramp lesions is associated with good healing, and it restores stability of knee. Follow-up of more than 2 years shows better functional outcome and reduced retear rates. Discussion/Conclusion: Currently, there are a lot of techniques described for ramp repair. We present arthroscopic ramp repair with dual posteromedial portals by shoelace technique, which is a safe, easy, and cost-effective method and gives excellent results and good healing especially in larger tears. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Shoelace technique for gradual closure of abdominal wall defect in a child

Shoelace technique for gradual closure of abdominal wall defect in a child

Suturing Dermatotraction Techniques in Closing Fasciotomy Wounds: A Systematic Review.

A surgical patient post-fasciotomy presents a challenge to restore the cover of the muscle groups, and the use of the suturing dermatotraction techniques presents a cheap and easy means of native cover. This systematic review of case series and case-control study explored the trend of this technique, including duration of delayed primary wound closure, complications, and failure rates. A literature review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted on Medline, Embase, and Cumulative Index of Nursing and Allied Health Literature (CINAHL), yielding a combined total of 820 articles between 1946 and June 18, 2022. Human studies with suturing dermatotraction techniques were included. Sixteen (16) studies reviewed met the criteria. The basic anatomy of the dermatotraction technique involves an anchor point on the skin, a material for traction, and a suture pattern. The shoelace technique was the predominant suture pattern, with staples as skin anchor material/method and silastic vessel loops as traction sling used by 11 studies. Modifications of this method included the use of intradermal Prolene sutures and pediatric catheters. The shortest duration for skin apposition was two days, and the longest was 113 days. Complications were comparable to that of surgical wounds and thus may not be attributable to the technique itself. Studies reviewed showed that superficial and early complications were more likely than deep or delayed complications. Negative pressure wound therapy (NPWT) and skin graft salvaged a few failed closures in two studies. There are varying practices of tightening rates with reports ranging from daily to every 72 hours. The rate of tightening and disease burden may account for the wide range of reported delayed primary closure. Most of the studies reviewed closed fasciotomy wounds with this technique within an average of <10 days. It is relatively cheaper, carries a low morbidity burden, and has multiple reported successin the closure of fasciotomy wounds in this review and thus should have an increased adoption as a first approach in managing fasciotomy wounds, especially in low-income countries.

Progressive flexor tendon sheath infection on hand after needle puncture during surgery: a case report

IntroductionFlexor tendon sheath infection may be due to trauma, laceration, or bites, commonly directly inoculating the sheath. Kanavel cardinal signs in flexor tendon sheath infection cases consist of symmetrical swelling of the entire digit, a digit with semi-flexed posture, exquisite tenderness along the course of the tendon sheath, and pain with attempted passive extension of the digit. Elevated levels of inflammation markers such as white blood cell count, erythrocyte sedimentation rate, and C-reactive protein are often found in such cases. Flexor tendon sheath infections require immediate diagnosis and treatment to prevent poor clinical outcomes. This paper reports one case of severe flexor tendon sheath infection with poor outcomes that required ray amputation of the affected finger.Case presentationA 35-year-old Sundanese male presented to the emergency department with right middle finger pain accompanied with swelling, blister, and blackened color 24 hours after accidental puncture by suture needle during gynecologic surgery. The patient was a resident physician of the obstetrics/gynecology department. The finger was necrotic with blisters at the proximal phalanx of the palmar aspect. Both the palmar and the dorsal aspects of the hand were swollen and inflamed, with firmer swelling on the dorsal part. The necrotic area had extended to the middle phalanx. The patient has been diagnosed with flexor tendon sheath infection with compartment syndrome. Immediate surgical debridement and fasciotomy with shoelace technique at the distal interphalangeal joint were performed. On the initial presentation, erythrocyte sedimentation rate, white blood cell count, and C-reactive protein were elevated. Smear culture was negative. A clear boundary of necrosis at the level of the middle phalanx of the right middle finger was found; subsequently, disarticulation at the level of the distal phalanx was performed. A ray amputation was performed to preserve the hand’s function for performing surgeries in the future.ConclusionPrompt diagnosis and treatment of flexor tendon sheath infection are required to prevent complications. Progressive inflammation around infected soft tissue due to untreated tenosynovitis may lead to poor outcomes and may lead to the amputation of the affected finger. This condition may occur even in medical professionals; as such, awareness for proper protection during any medical procedure and prompt treatment-seeking are encouraged.

Shoelace technique for the management of deep sternal wound infection.

In this article, we describe a practical technique of managing deep sternal wound infection by combining two dynamic wound closure methods, namely gradual approximation of the wound edges using vessel loops: the shoelace technique and the vacuumassisted closure system.

Reconstruction of a traumatic frontal skin defect using the vacuum-assisted shoelace technique and superficial temporal artery island flap: A case report

Reconstruction of a traumatic frontal skin defect using the vacuum-assisted shoelace technique and superficial temporal artery island flap: A case report

Application of combined negative pressure wound therapy and shoelace technique to the treatment of widespread femoral gas gangrene stemming from multiple open wounds in retroperitoneal perforations in ascending colon cancer

Application of combined negative pressure wound therapy and shoelace technique to the treatment of widespread femoral gas gangrene stemming from multiple open wounds in retroperitoneal perforations in ascending colon cancer

Shoe-Lace Technique Hasten Delayed Primary Closure In Fasciotomy Wound For Forearm Compartment Syndrome

We report a case of acute compartment syndrome of the forearm in a 51-year-old man with open fracture distal third radius (Gustilo I). Decompressive fasciotomy was performed promptly. Complete progressive closure of the wound without split-thickness skin grafting was achieved using a shoe-lace technique: silastic vessel loop were interlaced held together with skin staplers placed at the edge of the fasciotomy wound and were then tightened daily. Delayed primary closure of the fasciotomy wound was performed after 8 days post fasciotomy with complete opposition of skin edges without tension. Shoelace closure is a good option for atraumatic fasciotomy wound closure with good cosmesis result.

Does the shoe-lace technique aid direct closure of fasciotomy wounds after acute compartment syndrome of the lower leg? A retrospective case-control study.

Background and objective:Tibia fractures are relatively common injuries that are accompanied with acute compartment syndrome in approximately 2% to 20% of cases. Although the shoe-lace technique, where vessel loops are threaded in a crisscross fashion and tightened daily, has been widely used, no studies have compared the shoe-lace technique with the conventional one. The aim of this study was to compare the shoe-lace technique with the conventional technique.Methods:We identified 359 consecutive patients with intramedullary nailed tibia fracture and complete medical records including outpatient data between April 2007 and April 2015 from electronic patient database of our institute. The use of the shoe-lace technique was compared to conventional one (in which wounds were first left open with moist dressings). Main outcome measurement is direct closure of fasciotomy wounds.Results:From 359 consecutive patients with intramedullary nailed tibia fracture, fasciotomy was performed on 68 (19%) patients. Of these, the shoe-lace technique was used in 47 (69%) patients while in 21 (31%) patients, the shoe-lace technique was not applied. Side-to-side approximation was successful in 36 patients (77%) in the shoe-lace+ group and 7 patients (33%) in the shoe-lace– group (p = 0.002).Conclusions:The main finding of our comparative study was that the shoe-lace technique seems to ease direct closure of lower leg fasciotomy wounds, and thus reduces the frequency of free skin grafts. Our finding needs to be confirmed in a high-quality randomized controlled trial.

Utility of Shoelace Technique in Closure of Fasciotomy Wounds in Electric Burns.

Fasciotomy is indicated to relieve compartment syndrome caused by electric burns. Many techniques are available to close the fasciotomy wounds including vacuum-assisted closure, skin grafting, and healing by secondary intention. This study assessed the shoelace technique in fasciotomy wound closure in patients with electric burns. The study included 19 fasciotomy wounds that were treated by shoelace technique (Group ST, n = 10 fasciotomy wounds) or by skin grafting/healing by secondary intention (Group C, n = 9 fasciotomy wounds). Data were collected for wound surface area, time to intervention, time to wound closure, rate of decrease in wound surface area after application of shoelace technique and associated complications. The mean time to intervention after fasciotomy was significantly lower in Group ST-7.6 ± 3.8 days as compared to 15.8 ± 5.3 days in Group C (P = .004). The median time to closure was also significantly lower in Group ST-7 days (range 6-10) as compared to Group C-20 days (range 12-48) (P < .001). Primary closure was achieved in 80% cases in the group ST and no complications were recorded. The shoelace technique is an economical, fast, and effective method of fasciotomy wound closure in electric burns, especially in high volume centers and resource-limited areas.

Shoelace Technique Plus Negative-Pressure Wound Therapy Closure in Fasciotomy Wounds.

Fasciotomy incision closure is often performed with skin grafts that can lead to cosmetic and functional complications after surgical intervention. Because fasciotomy incisions do not result in skin loss, the authors hypothesized that better closure can be achieved by reducing tissue edema with negative-pressure wound therapy (NPWT) and reducing stress on the skin with the shoelace surgical technique. This 1-year prospective study included eight patients with acute compartment syndrome after extremity fractures and/or blunt injuries. Patients were treated with fasciotomies closed with the shoelace technique and NPWT for wound margin approximation. The NPWT device was changed every second day; the shoelace traction tension was tightened at the same time. The mean time from fasciotomy to wound closure was 11.8 days (range, 5-30 days). There was no need for a skin graft or flap in any patient. The shoelace technique plus NPWT may be successful in closing skin fasciotomies after acute compartment syndrome without causing additional morbidity.

Comparative study of delayed primary closure by shoelace technique versus conventional secondary suturing method in closure of fasciotomy wounds, done for spreading cellulitis with compartment syndrome

Background: Fasciotomy is a standard treatment for acute compartment syndrome. Historically, fasciotomy incisions were usually left open till oedema settles down. In literature, there is a wide range of wound closure techniques published, but none of them is deemed to be the best. In this study, focus is laid on whether delayed primary closure (DPC) by shoelace technique, is as effective as conventional secondary suturing, in closure of fasciotomy wounds, done for spreading cellulitis.Methods: All those patients who met below mentioned inclusion criteria and underwent fasciotomy, were allocated into 2 groups (A and B) where Group A consists of 30 patients undergoing conventional secondary suturing, whereas Group B consists of 30 patients undergoing DPC by shoelace technique for closure of fasciotomy wounds. Parameters such as duration of hospital stay, time taken for complete wound closure, local wound complications, hospital expenses, anaesthesia related complications between the two groups were compared.Results: Patients who underwent DPC for fasciotomy wound closure achieved wound closure ~7 days earlier with 5 days lesser hospital stay than that of those who underwent conventional secondary suturing. Average health care cost of Group B was significantly lower compared to Group A, but there was no statistically significant difference in incidence of wound infections between the two groups.Conclusions: DPC by shoelace technique, takes less time for wound closure and hence the need for nursing care and hospital stay is significantly reduced in comparison to the conventional secondary suturing method.

Delayed reconstruction for olecranon fracture with extensive soft tissue injury and bone loss: A case report

Delayed surgery for intraarticular fractures of the elbow is usually avoided, especially to prevent complications such as stiffness. We described an interesting case of a young patient who presented with open fracture of right olecranon, with extensive soft tissue injury and bony loss. He was treated with a 3-stage surgical procedure, prioritising on the soft tissue healing first before undergoing a delayed, definitive fixation of the olecranon, which was done 4 weeks after the trauma. The 3 stages include initial debridement and temporary skeletal stabilisation using Kirschner wires and external fixator, second look debridement with shoelace (dermato-traction) technique of delayed wound closure, and a definitive, reconstructive surgery using tricortical iliac bone graft with anatomical locking plate. The subsequent radiographs showed restored articular congruency of the elbow joint, before the olecranon eventually achieved bony union. He recovered well with excellent outcomes, as the elbow range of motion achieved almost full flexion at 120° and the extension lag at 10° and the Disabilities of the Arm, Shoulder and Hand (DASH) score of 3.3 was recorded. Delayed reconstructive surgery for olecranon fracture with extensive soft tissue and bone loss is a viable option to avoid complications, including infection and non-union. A judicious consideration by prioritising soft tissue management over expeditious bony surgery is important to achieve excellent outcomes.

Optimising Wound Closure Following a Fasciotomy: A narrative review.

Compartment syndrome is a surgical emergency that could be resolved by a fasciotomy. However, performing substantial skin incisions may lead to life-threatening complications. This narrative review aimed to present the available methods of wound closure and preferential factors for using each technique. Viable and non-infected wounds were most often treated by gradual approximation techniques, such as the simple or modified shoelace technique, the prepositioned intracutaneous suture or several commercially-available mechanical devices. In addition, applying negative pressure therapy was found to be feasible, particularly when combined with approximation techniques. Skin grafting was reserved for severely-dehiscent wounds while other non-invasive approaches were considered for other subsets of patients with inadvisable surgical interventions. Treatment decision should be made in view of the patient’s condition, ease of application, availability of resources, cost of treatment and aesthetic outcomes.

Management of extremity fasciotomy sites prospective randomized evaluation of two techniques

IntroductionMorbidity from the treatment of extremity compartment syndrome is underappreciated. Closure technique effectiveness has yet to be definitively established. MethodsA randomized non-blinded prospective study was performed involving patients who underwent an extremity fasciotomy following trauma. Shoelace wounds were strapped with vessel loops under tension and VAC wounds were treated with a standard KCI VAC dressing. After randomization, patients returned to the OR every 96 h until primarily closed or skin grafted. Results21 patients were consented for randomization with 11 (52%) successfully closed at the first re-operation. After interim analysis the study was closed early with 5/5 (100%) of wounds treated with the shoelace technique closed primarily and only 1/9 (11%) of VAC wounds closed primarily (p = 0.003). Overall primary closure was achieved in 74% of patients. ConclusionsAggressive attempts at wound closure lead to an increased early closure rate. For wounds that remain open after the first re-operation, a simple shoelace technique is more successful than a wound VAC for achieving same hospital stay skin closure.

Research progress in management of postoperative factors related to fasciotomy of compartment syndrome

The early treatments after fasciotomy of compartment syndrome mainly focused on metabolic disorder caused by ischemia-reperfusion injury, including hypokalemia, metabolic acidosis, rhabdomyolysis, and myoglobinuria. There was no evidence for conventional anticoagulation after surgery due to the risk of bleeding. Continuous negative pressure drainage was useful in reducing tissue damage caused by ischemia-reperfusion and improving tissue blood supply. In addition, hyperbaric oxygen was also effective in preventing tissue ischemia and necrosis after ischemia-reperfusion injury. In recent years, as the representative closure method of incision of fasciotomy, the shoe lace technique has been widely used in clinical practices, together with derived commercial products, the incidence of incision complications was effectively reduced. The author reviewed the progress in management of postoperative factors related to fasciotomy of compartment syndrome so as to provide reference for improving clinical curative effect. Key words: Compartment syndromes; Reperfusion injury; Fasciotomy