MODIFIED SHOELACE TECHNIQUE VS NPWT-ASSISTED SKIN APPROXIMATION FOR LOWER LIMB FASCIOTOMY WOUND CLOSURE: A PILOT RCT drishti.batra77@gmail.com

 

MODIFIED SHOELACE TECHNIQUE VS NPWT-ASSISTED SKIN APPROXIMATION FOR LOWER LIMB FASCIOTOMY WOUND CLOSURE: A PILOT RCT

11

Pratyusha Priyadarshini pratyushaaiims@yahoo.co.in JPNATC,AIIMS New Delhi Trauma Surgery and Critical Care Delhi India

Junaid Alam dr.junaidaiims@gmail.com JPNATC,AIIMS New Delhi Trauma Surgery and Critical Care Delhi India

Abhinav Kumar drabhinav1975@gmail.com JPNATC,AIIMS New Delhi Trauma Surgery and Critical Care Delhi India

 

India

Oral or Poster

Fasciotomy for lower limb compartment syndrome creates challenging wounds due to oedema and skin retraction. While NPWT and the shoelace technique both facilitate delayed primary closure, no consensus exists on optimal closure methods, particularly in resource-limited settings. This pilot RCT compares outcomes between modified shoelace technique and NPWT-assisted skin approximation in trauma patients.

This open-label pilot RCT was conducted at JPNATC,AIIMS New Delhi (January 2023-December 2024) among trauma patients aged 18-65 years requiring two-incision four-compartment lower limb fasciotomy. Patients with critical limb ischemia were excluded. Block randomization allocated patients to modified shoelace technique (n=21) using braided polyester sutures through titanium staplers with daily tightening, or NPWT (n=19) changed every 4-5 days. Primary outcome was delayed primary closure rate within 14 days. Secondary outcomes included time to closure and complications. STSG was performed as bailout if closure failed by day 14.

Forty patients were randomized (shoelace n=21, NPWT n=19) with comparable baseline characteristics. Delayed primary closure was achieved in 66.7% of shoelace cases versus none in NPWT (p<0.001); mean closure time was 11.4 days. Shoelace showed greater wound width reduction at 14 days (medial: 66.7% vs 27.6%, lateral: 64.6% vs 25.3%; p<0.001). Paraesthesia was less frequent with shoelace (5.9% vs 43.7%, p=0.013). Other complications, including infection, amputation, and mortality, were similar between groups

Modified shoelace technique offers significantly better delayed primary closure and wound healing than NPWT in lower limb fasciotomy wounds, with fewer sensory complications. This approach may improve outcomes and reduce morbidity in resource-limited trauma settings.