50 patients with acute compartment syndrome stemming from leg fracture and/or blunt injury undergoing leg fasciotomy were randomized to wound closure through either vacuum-assisted closure (VAC) or the shoelace technique. This study aimed to compare wound outcome, time to closure, and complications between these treatments. Results indicated significantly shorter time to wound closure, and significantly lower daily costs with the shoelace technique compared to VAC. Fasciotomy wound length and incidence of wound infection were similar, and there was a non-significant trend indicating a reduction in the need for additional split thickness skin grafting in the shoelace technique group.