Pilon Frx Wound Closure

- Discussion:
    - if the tourniquet is used, then it should be left elevated until wound closure is complete (expect wound swelling as soon as the tourniquet is released);
    - if swelling prevents tension free wound closure, anterior wound may be left open for DPC in 3-5 days when swelling subsides;
           - this reduceds the risk of medial flap necrosis from closing the wound under too much tension;
    - suturing both incisions will cause undue tension on one or other wound;
    - attempt to close tibial wound because of its proximity to anterior tibial tendon, & metal implant;
    - if lateral skin incision is made posterior to fibula, then plate will be covered by skin flap & postoperative problems will be minimal;
    - in some cases it is more prudent to avoid soft tissue tension by treating the fibular wound with a delayed closure or with immediate skin grafting;
            - also consider lateral STSG if excessive wound swelling is present;
    - in some cases, secondary soft tissue coverage for the leg will be necessary

Intraarticular "pilon" fracture of the tibia.

The management of the tissues in pilon fractures

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, November 26, 2012 1:19 pm