The Lacing Dermatotraction Suturing Technique
Venkataramana V.H. A. et al. - Lacing Dermatotraction Suturing Technique.


Secondary Closure

How to Cite

Venkataramana, A., Byadigere, M., Razack, A., Ranganath, H., Saniya, A., Arish, H., & Pattar, S. (2024). The Lacing Dermatotraction Suturing Technique. Albanian Journal of Trauma and Emergency Surgery, 8(1), 1335-1340.


Introduction: Hailing from a tertiary government-aided center, infected surgical wounds varying from diabetic foot and necrotizing fasciitis to surgical site infection are by far the most common cluster of cases encountered in our practice. Due to an overall lack of patient education on wounds, most of these patients present late, necessitating extensive debridement and tissue loss.

Aim and Objective: To describe the lacing dermatotraction technique and to study its application in aiding early secondary closure of infected surgical wounds.

Material and Methods: An interventional Study was conducted at VICTORIA Hospital, Bangalore, from February 2020 to October 2021. Fifty-four patients with Infected wounds were debrided until healthy margins were obtained, followed by applying the shoelace tension lacing suture. This consisted of an infant feeding tube running under loops of prolene fixed 1 cm away from the edge of the wound. One end of the IFT is anchored to the skin, and the other is held in position with single throws of no-1 silk suture, which can be loosened at the next sitting for adequate wound exposure, which aids in better debridement. The tension suture is again tightened to attain the maximal possible wound approximation.   Thus, constant traction on the skin edges creates progressive closure until secondary closure is achieved.

Results: 54 Patients were enrolled, consisting of 8 amputation stump infections, 11 diabetic foot, 14 disarticulations, five bed sore, 12 fasciotomies, three mastectomy flap necrosis, and one traumatic avulsion. There were 38 males and 16 females, with a mean age of 53.4 years. The mean duration of the wound at presentation was 17 days, and they were subjected to an average of 11 days of debridement. Mean wound dimensions - length= 11.02cm, breadth=4.86cm and area = 53.55 cm2. On applying the lacing, the wounds were debrided for an average of 8.85 days with 2.9 tightening. Secondary closure was achieved in 45 (83.33%) patients,.

Conclusion: The lacing technique is inexpensive and safe to achieve early secondary closure of infected wounds. It avoids the need for skin grafts, reducing the need for anesthesia, hospital expenditure, and duration of hospital stay of patients.
Venkataramana V.H. A. et al. - Lacing Dermatotraction Suturing Technique.


Vyas K., Vasconez H.C. Wound healing: Biologics, skin substitutes, biomembranes and scaffolds. Healthcare. 2014;2:356–400. doi: 10.3390/healthcare2030356.

Gustafsson, R., Johnsson, P., Algotsson, L., Blomquist, S., & Ingemansson, R. (2002). Vacuum-assisted closure therapy guided by C-reactive protein level in patients with deep sternal wound infection. The Journal of Thoracic and Cardiovascular Surgery, 123(5), 895–900. doi:10.1067/mtc.2002.121306

Everett JS, Sommers MS. Skin viscoelasticity: physiologic mechanisms, measurement issues, and application to nursing science. Biol Res Nurs. 2013;15(3):338–346. doi:10.1177/1099800411434151

Wilhelmi BJ, Blackwell SJ, Mancoll JS, Phillips LG. Creep vs. stretch: a review of the viscoelastic properties of skin. Ann Plast Surg. 1998 Aug;41(2):215-9. Review. PubMed PMID: 9718160.

Simman R, Phavixay L. Split-thickness skin grafts remain the gold standard for the closure of large acute and chronic wounds [published correction appears in J Am Col Certif Wound Spec. 2012 Jun;3(4):99-103]. J Am Col Certif Wound Spec. 2011;3(3):55–59. doi:10.1016/j.jcws.2012.03.001.

R.M. Dodenhoff, G.E. Howell. The shoelace technique for wound closure in open fractures: report of early experience Injury, 28 (1997), pp. 593-595

Unal S, Ersoz G, Demirkan F, Arslan E, Tütüncü N, Sari A. Analysis of skin-graft loss due to infection: infection-related graft loss. Ann Plast Surg.2005 Jul;55(1):102-6.

Anderson, Jhon Jet al. “split-thickness skin grafts for the treatment of non-healing foot and leg ulcers in patients with diabetes: a retrospective review” Diabetic foot and ankle vol.3(2012)

Ramanujum CL, Stapleston JJ, “Split thickness graft for closure of diabetic foot and ankle wounds: a retrospective review of 83 patients”, Foot Ankle Spec (2010).

Muhammad Abdur Razzak, MD. Sanower Hossain “Cellular and molecular responses to mechanical expansion of tissue”, Front Physiol (2016)

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