Shoelace technique for delayed primary closure of fasciotomies

Performing a timely fasciotomy for compartment syndrome prevents ischemic injury to muscles and nerves. Fasciotomy entails incision of the overlying skin and investing fascia of the compartment, relieving pressure and enhancing tissue perfusion. Delayed primary closure is ideal, but because of skin edge retraction, the open wound must either heal secondarily or be closed with a split-thickness skin graft. The shoelace technique involves running a silastic vessel loop through skin staples placed at the skin edge along the initial fasciotomy incision. Daily tightening of the shoelace permits gradual reapproximation of the skin edges while compartment edema resolves. Closure using a simple suture or Steri-strip (3M Surgical Products, St. Paul, Minnesota) is then possible after 5 to 10 days. The shoelace technique allows for gradual primary closure of open fasciotomy wounds, thereby avoiding the morbidity and cost associated with skin graft or secondary closure.