Role of Pie Crusting Technique on Soft Tissues in Preventing Soft Tissue Complications Compared to Conventional Closure of Wound in Fractures of Distal Tibia (PILON) and Fibula

Article Information

Title: Role of Pie Crusting Technique on Soft Tissues in Preventing Soft Tissue Complications Compared to Conventional Closure of Wound in Fractures of Distal Tibia (PILON) and Fibula

Authors: Rana Shahbaz Ahmad, Muhammad Suhail Amin, Bushra Hassan, Muhammad Omar Rathore, Muhammad Rehan, Mohsin Javid

Journal: Pakistan Armed Forces Medical Journal (PAFMJ)

HEC Recognition History

Category	From	To
Y	2024-10-01	2025-12-31
Y	2023-07-01	2024-09-30
Y	2021-07-01	2022-06-30
Y	2020-07-01	2021-06-30
Y	1900-01-01	2005-06-30

Publisher: Army Medical College, Rawalpindi.

Country: Pakistan

Year: 2022

Volume: 72

Issue: 2

Language: English

DOI: 10.51253/pafmj.v72i2.5833

Keywords: Conventional closure of wound-deep wound infection and necrosis-fractures of distal tibia/pilon-open reduction and internal fixation [ORIF]-pie crusting technique-superficial wound infection and necrosis

Abstract

Objective: To demonstrate the effect of performing pie crusting on skin bridging two incisions used for open reduction and fixation to reduce wound complications compared to conventional wound closure.
Study Design: Quasi-experimental study.
Place and Duration of Study: Department of Orthopedics and Trauma, Combined Military Hospital Rawalpindi from Jan to Nov 2020.
Methodology: Forty-seven patients, managed primarily with open reduction and internal fixation for type-43 fractures per AO/OTA classification, were studied. Group-1 comprised patients in whom the pie crusting technique was used during the closure of the wound. Group-2 included patients in whom conventional closure of the wound was performed. Evaluation of complications in the presence or absence of superficial and deep infection and necrosis was done. The time from injury to surgery was 6 hours to 72 hours. Patients were followed for an average of 12 weeks.
Results: In group-1 (pie-crust technique), there were 23 patients, whereas group-2 (classic wound closure) comprised 24 patients. In group-1, only 1 (4%) patient had a superficial infection, and no deep infection was reported. Whereas in group-2, six patients (25%) had superficial infection, and two patients (8%) had the deep infection.
Conclusion: Results indicated that pie-crust technique significantly reduces the risk of superficial and deep wound complications compared to classic wound closure because it reduces skin tension and allows the drainage of subcutaneous fluids.

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Research Objective

To demonstrate the effect of performing pie crusting on skin bridging two incisions used for open reduction and fixation to reduce wound complications compared to conventional wound closure.

Methodology

Quasi-experimental study involving 47 patients with type-43 fractures of the distal tibia (pilon) and fibula, managed with open reduction and internal fixation. Patients were divided into two groups: Group-1 (pie crusting technique used during wound closure) and Group-2 (conventional wound closure). Complications such as superficial and deep infection, and necrosis were evaluated. Data was analyzed using SPSS version 26.0, with a p-value of 0.05 considered statistically significant.

Methodology Flowchart

                        graph TD;
    A["Patient Recruitment 47 patients with distal tibia/fibula fractures"] --> B["Group Allocation"];
    B --> C["Group 1: Pie Crusting Technique n=23"];
    B --> D["Group 2: Conventional Closure n=24"];
    C --> E["Open Reduction and Internal Fixation"];
    D --> E;
    E --> F["Wound Closure"];
    F --> G["Post-operative Follow-up 12 weeks"];
    G --> H["Evaluation of Complications Infection, Necrosis"];
    H --> I["Data Analysis SPSS"];
    I --> J["Conclusion"];

Discussion

The pie-crust technique significantly reduces the risk of wound complications by decreasing skin tension and facilitating the drainage of subcutaneous fluids. This is particularly important in complex fractures of the distal tibia (pilon) where soft tissue damage is often extensive. While ORIF is effective for achieving optimal reduction, wound complications remain a concern. The pie-crust technique, combined with adequate skin bridging, appears to be a valuable adjunct in minimizing these risks.

Key Findings

In Group-1 (pie crusting technique), 1 out of 23 patients (4%) had a superficial infection, and no deep infections were reported. In Group-2 (conventional closure), 6 out of 24 patients (25%) had superficial infections, and 2 patients (8%) had deep infections. The pie-crust technique significantly reduced the risk of superficial and deep wound complications.

Conclusion

The pie-crust technique significantly reduces the risk of superficial and deep wound complications compared to classic wound closure in patients undergoing open reduction and internal fixation for distal tibia/pilon and fibula fractures. This is attributed to its ability to reduce skin tension and allow for subcutaneous fluid drainage.

Fact Check

1. Study Duration: The study was conducted from January 2020 to November 2020. (Confirmed in Methodology section).
2. Sample Size: A total of 47 patients were included in the study. (Confirmed in Methodology and Results sections).
3. Superficial Infection Rate (Group 2): 25% of patients in the conventional closure group experienced superficial infections. (Confirmed in Results section).

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