The Use of Vessel Loop Shoelace Technique for Closure of Wound Dehiscence Caused by Dural Tears Associated with Distractive Flexion Injury of Cervical Spine

Hong Moon Sohn; Jae Won You; Sang Soo Park; Bo Seon Kim

doi:10.4184/jkss.2015.22.3.109

Journal List > J Korean Soc Spine Surg > v.22(3) > 1076054

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Sohn, You, Park, and Kim: The Use of Vessel Loop Shoelace Technique for Closure of Wound Dehiscence Caused by Dural Tears Associated with Distractive Flexion Injury of Cervical Spine

Case Report

Journal of Korean Spine Surg 2015;22(3):109-113.

Published online: 21 September 2015

DOI: https://doi.org/10.4184/jkss.2015.22.3.109

The Use of Vessel Loop Shoelace Technique for Closure of Wound Dehiscence Caused by Dural Tears Associated with Distractive Flexion Injury of Cervical Spine

Hong Moon Sohn, M.D., Jae Won You, M.D., Sang Soo Park, M.D., Bo Seon Kim, M.D.

Department of Orthopaedic Surgery, School of Medicine, Chosun University, Gwangju, Korea

Corresponding author: Sang Soo Park, M.D. Department of Orthopaedic Surgery, Chosun University Hospital, 365, Pilmun-daro, Gwangju 61453, Republic of Korea TEL: +82-62-220-3147, FAX: +82-62-226-3379 E-mail: wwwpibak@daum.net

Received 6 February 2015 Revised 10 March 2015 Accepted 28 July 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

A case report.

Objectives

To report the use of the shoelace technique for treatment of wound dehiscence caused by dural tears.

Summary of Literature Review

It is difficult to treat wound dehiscence caused by dural tears, as it can lead to infection, loss of soft tissue, and need for a long hospital stay.

Materials and Methods

An 18-year-old male who had been injured in a traffic accident was diagnosed with bilateral facet dislocation of C7-T1, with no neurologic deficit. Clear secretion appeared during the operation, but it disappeared after posterior fusion. The wound began to open about 3 weeks after the operation. We used the vessel loop shoelace technique to suture the wound,

Results

The patient had the stitches taken out in the outpatient clinic three weeks after suture. His wounds are healing without complication.

Conclusion

The vessel loop shoelace technique may be a useful treatment for wound dehiscence caused by dural tears.

Keywords: Distractive-flexion injury, Dural tear, Wound dehiscence, Shoelace technique

REFERENCES

1. Luszczyk MJ, Blaisdell GY, Wiater BP, et al. Traumatic dural tears: what do we know and are they a problem? Spine J. 2014; 14:49–56.

2. Khan MH, Rihn J, Steele G, et al. Postoperative management protocol for incidental dural tears during degenerative lumbar spine surgery: a review of 3,183 consecutive degenerative lumbar cases. Spine (Phila Pa 1976). 2006; 31:2609–13.

3. Wang JC, Bohlman HH, Riew KD. Dural tears secondary to operations on the lumbar spine. Management and results after a two-year-minimum followup of eighty-eight patients. J Bone Joint Surg Am. 1998; 80:1728–32.

4. Fountas KN, Kapsalaki EZ, Johnston KW. Cerebrospinal fluid fistula secondary to dural tear in anterior cervical discectomy and fusion: case report. Spine (Phila Pa 1976). 2005; 30:E277–80.

5. Cammisa FP, Jr., Girardi FP, Sangani PK, Parvataneni HK, 6. Hannallah D, Lee J, Khan M, Donaldson WF, Kang JD. Cerebrospinal fluid leaks following cervical spine surgery. J Bone Joint Surg Am. 2008; 90:1101–5.

7. Asgari MM, Spinelli HM. The vessel loop shoelace technique for closure of fasciotomy wounds. Ann Plast Surg. 2000; 44:225–9.

8. Eid A, Elsoufy M. Shoelace wound closure for the management of fracture-related fasciotomy wounds. ISRN Orthop. 2012; 2012:528382.

9. Mahindra P, Bassi JL, Bassi D, et al. Shoe lace suture technique for management of lower limb diabetic amputations- a study of 24 cases. Pb Journal of Orthopaedics. 2011; 7:31–3.

10. Fowler JR, Kleiner MT, Das R, Gaughan JP, Rehman S. Assisted closure of fasciotomy wounds: A descriptive series and caution in patients with vascular injury. Bone Joint Res. 2012; 1:31–5.

Fig. 1.

(A-B) The initial anteroposterior and lateral view of plain radiographs. (C-E) Initial CT coronal and sagittal images. There was a bilateral facet dislocation of distractive flexion stage III between C7 and T1.

Fig. 2.

(A-B) The anteroposterior and lateral view of plain radiographs after closed reduction. (C-D) T2-weighted axial images and T2-weighted fat-suppressed sagittal images after closed reduction. MRI images shows compression fracture in T1, high signal intensity within the spinal cord between C7 and T1 and posterior ligament complex injury.

Fig. 3.

(A-B) Anteroposterior and lateral views of plain radiographs after posterior fusion with screw, rod, and wire. (C-F) Axial and sagittal CT images after operation.

Fig. 4.

(A) Clinical photo 3 days after operation, 2cc of bloody discharge drained out. (B-C) 10 days after operation, serosanguineous discharge was seen. (D) 22 days after operation, wound disruption was seen, as well as loss of soft tissue elasticity and viability. The size was about 2×8 cm. (E) Wound repair was done using the vessel loop shoelace technique.

Fig. 5.

(A) Clinical photo 7 days after wound repair. No discharge was seen. (B) 14 days after wound repair. (C) 21 days after wound repair, (D) The wound completely healed after all of the stitches were removed.

Fig. 6.

(A-B) Anteroposterior and lateral views of plain radiographs and clinical photo taken after one year followup.

TOOLS

Similar articles