ER: Economical Resection with Shoelaces
When shoelaces become a perfect aid for surgeries
Translated from: 急診室的鞋帶
Before the Surgery
Lady Shoelace, what are you doing up here in our emergency room? Don’t you know that we are not open to the public? The waiting room is right over there. Please, leave.
Whoa, whoa, wait a minute! Hear what you are saying! Let me warn you, you’d be mortified and put on the operating table once you know my mission here.
What exactly is the true face of Lady Shoelace?
Why is she in the emergency room?
Let’s see and find out.
During the Surgery
Haleh, give me the scalpel! This patient is experiencing great pressure in his thigh. Poor blood circulation. I’m afraid he’s suffering from compartment syndrome, which is going to terribly kill his tissues around the thigh.
Dr. Ross, do you mean that his right thigh is bearing to much internal and/or external pressure, and thus results in compartment syndrome? If that’s the case, we better operate a Fasciotomy on his thigh, relieving the tensions by cutting open the fascia that covers the muscles, nerves, and blood vessels inside.
You’re fast! That’s correct! [Slowly cutting open the patient’s right thigh]
But wait, I have a question. Normally, after a patient undergoes a Fasciotomy, skin contractures would occur, making the recovery from the injury less optimistic, sometimes even resulting in tissue edema. What should we do about this then?
Don’t you worry, Haleh. To avoid what you just said, we have to go through another surgical procedure, which is known as the “Shoelace Technique”. It is a form of suture technique that copies the way we tie our shoelaces. First, I will embed surgical staples in the surrounding area of his skin, just like pinching shoelace holes. Each staple will be approximately 2 centimeters apart and 1cm from the edge of the injury (Jeng et al., 2003; Saini et al., 2018). Later, we either use a silk or elastic suture to fix through the embedded staples in a zig-zag fashion. This way, the wounds would close much faster, and even prettier.
Wow, Dr. Ross, this “Shoelace Technique” you’re talking about sounds amazing! I think I’ve read it somewhere in a medical journal. If my memory were right, this suture technique was founded in 1986 by Dr. Bruce Cohn and his colleagues. Not only can it help a wound heal within 2 weeks, it is also a one-time surgery that requires lower medical expenses on the part of the hospital as well as less health care cost for the patient. Furthermore, patients are allowed better tolerance while in the toilet (Ching et al., 2009; Saini et al., 2018).
It seems, I’ve got you wrong. It still amazes me how you can greatly reduce the cost for performing a Fasciotomy! Please accept my sincere apology!
Well, well, you really should be sorry…Just kidding! Apologies accepted! When you see me hanging around next time, be reminded that I’m here on an important mission: to help perform the “Shoelace Technique”.
Jeng, C. H., Young, S. Y., Tsai, Y. C. & Lin, H. C. (2003). The loop shoelace technique: An alternative method for closure of Fasciotomy wounds. Journal of Plastic Surgery Association Taiwan, 12(3), 204-210.
Ching, W. C., Lin, Y. T., Hsu, C. C., Lin, C. H. & Lin, C. H. (2009). Using modified shoelace technique in closing wounds other than Fasciotomies. Journal of Plastic Surgery Association Taiwan, 18(2), 123-130.
Cohn, B. T., Shall, J. & Berkowitz, M. (1986). Forearm Fasciotomy for acute compartment syndrome: A technique for delayed primary closure. Orthopedics, 9(9), 1243-1246.
Compartment Syndrome (n.d.). In WebMD. Retrieved from https://www.webmd.com/pain-management/guide/compartment-syndrome-causes-treatments#1
Fascia. (n.d.). In Science Direct. Retrieved from https://www.sciencedirect.com/topics/medicine-and-dentistry/fascia
Saini, R. A., Sharma, D. & Shah, N. (2018). Shoe lace technique, a simple and less expensive method for Fasciotomy wound closure following compartment syndrome. International Journal of Orthopaedics Sciences, 4(1), 445-449.
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