title: A prospective study evaluating incision placement and wound healing for tibial plafond fractures.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Prospective observational cohort.
  
  
  METHODS
  Level 1 Trauma Center.
  
  
  METHODS
  A total 42 patients with 46 tibial plafond fractures.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Orthopaedic Surgery and Sports Medicine, Harborview Medical Center, Seattle, WA 98104, USA.
authors.forename: James L
authors.initials: JL
authors.lastname: Howard
authors.forename: Julie
authors.initials: J
authors.lastname: Agel
authors.forename: David P
authors.initials: DP
authors.lastname: Barei
authors.forename: Stephen K
authors.initials: SK
authors.lastname: Benirschke
authors.forename: Sean E
authors.initials: SE
authors.lastname: Nork
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D062109:Dermatologic Surgical Procedures; D004210:Dissection / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D006801:Humans; D016268:Internal Fixators; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D040521:Subcutaneous Tissue / Q000601:surgery*; D013978:Tibial Fractures / Q000601:surgery*; D016896:Treatment Outcome; D014945:Wound Healing