Howard James L, Agel Julie, Barei David P, Benirschke Stephen K, Nork Sean E
Department of Orthopaedic Surgery and Sports Medicine, Harborview Medical Center, Seattle, WA 98104, USA.
J Orthop Trauma. 2008 May-Jun;22(5):299-305; discussion 305-6. doi: 10.1097/BOT.0b013e318172c811.
To report the soft tissue complications after fixation of tibial plafond fractures to test the validity of the recommendation that a 7-cm skin bridge represents the minimum safe distance between surgical incisions.
Prospective observational cohort.
Level 1 Trauma Center.
A total 42 patients with 46 tibial plafond fractures.
All injuries had a minimum of 2 surgical approaches for operative management of the tibial plafond and associated fibula fracture (if applicable). Two low-energy injuries had single-stage open reduction internal fixation of the tibia and fibula, and the remaining high- energy fractures had a 2-staged approach to management.
The surgical approaches used, length of the incisions, distance between the incisions, and overlap between the incisions were recorded. Wound healing was assessed in the outpatient clinic over a 3-month period.
Two surgical approaches were used in 32 fractures, and 3 approaches were used in 14 fractures. The mean width of the skin bridge was 5.9 cm. The majority of the skin bridges were 5.0 to 5.9 cm (n = 25) or 6.0 to 6.9 cm (n = 16). Only 17% of the skin bridges were greater than 7.0 cm. Soft tissue complications occurred in 4 (9%) of 46 fractures. Healing of 2 anterolateral incisions was complicated by eschars that ultimately resolved with local wound care. One posterolateral fibular incision failed to heal until the fibular plate was removed. One patient required subsequent surgical procedures for infection.
Despite a measured skin bridge of less than 7 cm in 83% of instances, the soft tissue complication rate was low in this group of tibial plafond fractures. With careful attention to soft tissue management and surgical timing, incisions for tibial plafond fractures may be placed less than 7 cm apart, allowing the surgeon to optimize exposures on the basis of injury pattern.
报告胫骨平台骨折固定术后的软组织并发症，以检验“7厘米皮桥是手术切口间最小安全距离”这一建议的有效性。
前瞻性观察队列研究。
一级创伤中心。
42例患者共46处胫骨平台骨折。
所有损伤至少采用两种手术入路来处理胫骨平台及相关腓骨骨折（如适用）。2例低能量损伤行胫腓骨一期切开复位内固定术，其余高能量骨折采用两阶段处理方法。
记录手术入路、切口长度、切口间距离及切口重叠情况。在门诊对伤口愈合情况进行为期3个月的评估。
32处骨折采用两种手术入路，14处骨折采用三种手术入路。皮桥平均宽度为5.9厘米。大多数皮桥为5.0至5.9厘米（n = 25）或6.0至6.9厘米（n = 16）。只有17%的皮桥大于7.0厘米。46处骨折中有4处（9%）发生软组织并发症。2处前外侧切口愈合时出现焦痂，最终经局部伤口护理得以解决。1处后外侧腓骨切口直至取出腓骨钢板才愈合。1例患者因感染需要后续手术治疗。
尽管83%的病例中测得的皮桥小于7厘米，但该组胫骨平台骨折的软组织并发症发生率较低。通过仔细关注软组织处理和手术时机，胫骨平台骨折的切口间距可小于7厘米，使外科医生能够根据损伤类型优化暴露范围。
