Modified Shoelace Closure With Kirschner Wires After Forearm Fasciotomy for Rattlesnake Bite-Related Compartment Syndrome in a Pediatric Patient: A Case Report

Snakebite envenomation may cause severe local tissue injury; although compartment syndrome is uncommon, it represents a surgical emergency when present. We report the case of an 11-year-old male who presented four hours after a rattlesnake bite to the left hand with pallor, delayed capillary refill, decreased distal temperature, diminished pulses, and paresthesias. Emergency fasciotomy of the forearm and hand was performed, revealing marked edema under tension with preserved muscle viability. Seven days later, delayed closure was achieved using a modified shoelace dermatotraction technique with 1.5 mm Kirschner wires, polyester 0 sutures, and silicone protectors fashioned from Nelaton catheter segments. Progressive closure was completed over 72 hours without the need for skin grafting or negative pressure wound therapy. The patient had an uneventful recovery, and at eight-month follow-up, he demonstrated preserved range of motion, intact sensation, strength graded at 4/5, and satisfactory scar evolution. This case shows that an established dermatotraction technique can be adapted to available resources to achieve effective fasciotomy closure in selected patients.