Akgun Ulas, Canbek Umut, Kilinc Cem Yalin, Acan Ahmet Emrah, Karalezli Nazim, Aydogan Nevres Hurriyet
Assistant Professor, Department of Orthopaedics and Traumatology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey.
Assistant Professor, Department of Orthopaedics and Traumatology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey.
J Foot Ankle Surg. 2019 May;58(3):497-501. doi: 10.1053/j.jfas.2018.09.027. Epub 2019 Feb 13.
Distal tibia and fibula fractures are challenging injuries to treat as evidenced by the high rates of wound complications because of vulnerable soft tissue coverage. The aim of this study was to examine the effect on soft tissue complications of the pie-crusting technique when applied between 2 incisions in distal tibia and fibula fractures treated with open reduction and internal fixation. We reviewed 34 patients with distal tibia and fibula fractures treated between September 2014 and March 2017. The pie-crusting technique was performed during wound closure in 16 (47.06%) fractures (group 1) and classic wound closure was done in 18 (52.94%) fractures (group 2). The primary outcome was evaluated as the presence or absence of soft tissue complications such as superficial skin necrosis, deep skin necrosis, and deep infection. The mean age was 50.44 ± 13.51 (range 23 to 65) years in group 1 and 51.67 ± 14.49 (range 18 to 68) years in group 2. The mean follow-up time was 27.35 ± 9.02 (range 16 to 46) months. The mean surgery time after injury was 5.88 ± 3.5 (range 1 to 14) days in group 1 and 7.32 ± 4.25 (range 1 to 16) days in group 2. No soft tissue complications were seen in any patient in group 1. Five (27.77%) occurrences of superficial skin necrosis were observed in group 2. In 2 (11.11%) patients in group 2, deep necrosis and wound dehiscence occurred, and subsequent deep infection developed in 1 (5.55%) of these patients. The overall complication rate was higher in group 2 (p = .005). We believe that the pie-crusting technique is beneficial for wound closure in distal tibia and fibula fractures, because it reduces the tension of the skin and allows leakage of subcutaneous fluids.
胫腓骨远端骨折因软组织覆盖薄弱，伤口并发症发生率高，治疗颇具挑战性。本研究旨在探讨在切开复位内固定治疗的胫腓骨远端骨折中，于两个切口之间应用“馅饼皮”技术对软组织并发症的影响。我们回顾了2014年9月至2017年3月期间治疗的34例胫腓骨远端骨折患者。16例（47.06%）骨折在伤口闭合时采用了“馅饼皮”技术（第1组），18例（52.94%）骨折采用了传统伤口闭合方法（第2组）。主要结局评估为是否存在软组织并发症，如浅表皮肤坏死、深部皮肤坏死和深部感染。第1组患者的平均年龄为50.44±13.51岁（范围23至65岁），第2组为51.67±14.49岁（范围18至68岁）。平均随访时间为27.35±9.02个月（范围16至46个月）。第1组受伤后平均手术时间为5.88±3.5天（范围1至14天），第2组为7.32±4.25天（范围1至至16天）。第1组患者均未出现软组织并发症。第2组观察到5例（27.77%）浅表皮肤坏死。第2组有2例（11.11%）患者发生深部坏死和伤口裂开，其中1例（5.55%）随后发生深部感染。第2组的总体并发症发生率更高（p = 0.005）。我们认为，“馅饼皮”技术有利于胫腓骨远端骨折的伤口闭合，因为它可减轻皮肤张力并使皮下液体渗出。
