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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