Compartment syndrome is a common complication after revascularization for acute lower extremity ischemia. Treatment with four compartment fasciotomy can result in significant morbidity, with wounds that are challenging to manage for both the patient and practitioner.

An alternative to wound VAC or simple wet-to-dry dressings, the “Roman sandal” technique makes bedside closure of these wounds possible, especially in patients with minimal postdecompression muscle edema.

After completion of the fasciotomy, staples are placed parallel to the incision, both anteriorly and posteriorly, spaced several centimeters apart. A large vessel loop is then strung between the staples, similar to lacing shoelaces. As the muscle edema improves, the skin is gradually closed by pulling on the loops to tighten them while tying a silk suture or placing a staple to maintain the tension on the loop. This technique results in closure of the incision without needing a return to the operating room.

Dr. Hershberger is an attending surgeon at Sarasota Vascular Specialists, Sarasota, Fla.