Clinical Outcomes of Shoelace-Assisted Wound Closure in Large Traumatic and Fasciotomy Defects: A Prospective Observational Cohort Study at a Tertiary Orthopedic Trauma Institute

Open Access

Abstract

Background: Progressive dermatotraction through the shoelace technique represents an economical and simple strategy for managing extensive traumatic and fasciotomy-related wounds. This investigation assessed its clinical performance and safety profile. Objectives: To evaluate clinical outcomes using the shoelace suturing method in patients presenting with large traumatic or fasciotomy wounds exceeding 50 cm² post-debridement. Methods & Materials: A prospective cohort investigation was performed at the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh, spanning June 2021 to June 2026. Thirty consecutive patients with substantial post-debridement wounds underwent treatment with progressive shoelace fixation at 24-72-hour intervals. Primary outcome was successful wound approximation and definitive closure without flap reconstruction. Secondary measures included time to healing, number of tightening cycles, need for skin autografting, adverse events, and duration of hospitalization. Results: Participant cohort included 19 males and 11 females (mean age 38.6 ± 14.2 years). Eighteen wounds resulted from blunt or penetrating injury, while 12 arose from compartment syndrome fasciotomy. Mean wound surface area was 95.2 ± 38.6 cm². Successful definitive closure without flap reconstruction occurred in 28 patients (93.3%). Four cases required autografting (13.3%), and two necessitated flap reconstruction (6.7%). Average interval to complete closure measured 8.8 ± 4.1 days. Adverse events included wound infection (n=3, 10.0%), marginal necrosis (n=1, 3.3%), and partial separation (n=1, 3.3%). Mean hospitalization duration was 13.0 ± 5.2 days. Conclusions: In appropriately selected patients, the shoelace-assisted closure technique demonstrates substantial efficacy for wound-margin approximation with high rates of primary closure without flap reconstruction in large traumatic and fasciotomy wounds.