| Summary: | Introduction: skin closure in an area with large tissue defects and low laxity is always a challenge for plastic surgeons, especially in the pediatric population. The shoelace technique is a gradual closure modality for large wounds with minimal margin elasticity. Case presentation: we report the successful use of this modality for a large abdominal wound defect following laparotomy in a 6-year-old boy. A complete margin approximation was achieved with a unique linear scar and no sign of hypertrophy, contracture, or deep adherence at 1 year postoperatively. Discussion: Although options for the closure of a large skin defect are numerous, decision-making in pediatric reconstructive surgery stays complex. This population is poorly represented in the literature, and evidence must be extrapolated from adult studies. Conclusion: Staged closure using the shoelace technique is a low-cost, accessible, and reproductive modality. It decreases the surface of needed tissue if associated with other modalities and provides a unique scar if used alone.
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