- 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;
Intra-articular pilon fracture of the tibia.
DL Helfet et al.
CORR Vol 298 1994. p 221-228;
The management of the tissues in pilon fractures.
Leone VJ.
Clin Orthop 292:315-320, 1993
