J Korean Soc Spine Surg.  2015 Sep;22(3):109-113. 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

• Sohn HM
• You JW
• Park SS
• Kim BS

• KMID: 2068929
• DOI: http://doi.org/10.4184/jkss.2015.22.3.109

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

Keyword

Distractive-flexion injury; Dural tear; Wound dehiscence; Shoelace technique

MeSH Terms

Accidents, Traffic
Adolescent
Ambulatory Care Facilities
Dislocations
Humans
Length of Stay
Male
Neurologic Manifestations
Spine*
Sutures
Tears*
Wounds and Injuries*

Figure

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  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.

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  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.

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  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.

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  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.

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  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.

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  Fig. 6. (A-B) Anteroposterior and lateral views of plain radiographs and clinical photo taken after one year followup.

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