Clinical Application of Suture Distraction Technique for Closure of Decompression Incisions Following Lower-Leg Compartment Syndrome: A Retrospective Cohort Study

Why clinicians should know about it

• Picked for Plastic and Reconstructive Surgery (paper of the day, 29 October 2026): Comparative fasciotomy wound closure, scars, sensation, and graft avoidance

Abstract

Objectives: The objective of this study was to assess the suture distraction technique (SDT) for closing decompression wounds resulting from acute compartment syndrome (ACS) of the lower leg, and to examine whether it may serve as an alternative to skin grafting (SG). Methods: We retrospectively reviewed 67 patients who received decompressive fasciotomy for lower-leg ACS from January 2018 to June 2025. Of these, 31 were managed with SDT and 36 with SG. Wound healing time served as the primary outcome; secondary outcomes comprised the number of operations, hospital stay, wound-closure-related costs, sensory function, Vancouver Scar Scale (VSS) scores, donor-site injury, and infection rate. Results: The two groups were broadly similar in baseline characteristics. Compared with the SG group, the SDT group required fewer operations (median 1.0 vs. 2.0), achieved faster wound healing (14.0 vs. 18.5 days), had shorter hospital stays (27.0 vs. 46.0 days), and incurred lower wound-closure-related costs (1656 vs. 14,926.5 CNY) (all p < 0.001). VSS scores favored the SDT group (0.0 vs. 4.0, p < 0.001). All SDT patients preserved normal sensation, whereas all SG patients experienced hypoesthesia (p < 0.001). As an inherent consequence of skin grafting, every grafted patient had a donor-site wound, whereas no SDT patient required grafting and therefore had none; donor-site morbidity was described descriptively rather than compared statistically. The infection rate did not differ significantly between groups (p = 0.495); however, given the small number of events, no firm conclusion could be drawn. In the parsimonious adjusted analysis, the SG group had a significantly longer wound healing time (adjusted ratio, 1.412; 95% CI, 1.303 to 1.531; p < 0.001). The time from injury to fasciotomy was significantly longer in the SG group than in the SDT group (median 5.7 vs. 4.5 h; p = 0.012). Conclusions: Within this single-center retrospective cohort, SDT was linked to fewer operations, shorter wound healing time and hospital stay, and reduced costs, while preserving sensation and avoiding donor-site morbidity. As the decompression incision in ACS involves no actual loss of skin, this wound type may be particularly well suited to SDT, which enabled complete closure without skin grafting in the present cohort. These findings merit confirmation through prospective comparative studies.

Abstract as published, via PubMed.