Introduction: Treatment of compartment syndrome typically mandates surgical decompression. Fasciotomy wounds are traditionally left to heal by secondary intention or covered with a split thickness skin graft. In the last two decades, there have been a variety of methods described in the literature with the goal of achieving delayed primary skin closure in order to improve cosmetic outcome and patient satisfaction.

Methods: A 20 year old male was a pedestrian struck by a car. He arrived to the ED stable, alert, and complaining of left lower leg pain. On exam there was no deformity; however, he had a tense and painful calf. Motor and sensory examination of his foot was intact, and films were negative for fracture. His anterior compartment pressure was measured at 55mm Hg; he was therefore taken to the OR for emergent fasciotomy. At the time of fasciotomy, delayed primary closure of his wounds was anticipated using the shoelace technique. This video demonstrates initial fasciotomy and vessel loop placement, bedside tightening, and subsequent wound closure.

Conclusion: The shoelace technique is a quick, simple, and inexpensive means to achieve delayed primary skin closure after fasciotomy which also avoids the scars of skin grafts. The use of vessel loops prevents skin adherence to the underlying tissues allowing bedside wound approximation and eventual definitive skin closure. This technique is more cost effective than utilizing expensive equipment (e.g. vacuumassisted device) and potentially shortens the hospital length of stay.