Abstract
Background Placement and spacing of skin incisions are important for maintaining soft tissue
perfusion and viability, particularly in the setting of local trauma.
Question/Purpose The aim of this article is to determine if multiple skin incisions in the surgical
management of distal radius fractures result in an increased risk of postoperative
wound complications, particularly in the setting of high-energy mechanisms of injury
with substantial initial displacement and associated soft-tissue insult that require
multiple incisions for distal radius reconstruction.
Patients and Methods A multicenter, retrospective chart review was performed for all adult patients who
underwent open reduction, internal fixation of a closed distal radius fracture with
multiple (≥2) hand, and wrist incisions with minimum follow-up of 6 weeks. Primary
outcome measures included wound healing complications such as partial or complete
skin necrosis, dehiscence, delayed healing, and superficial or deep infections.
Results For 118 wrists, a total of 305 incisions were utilized, averaging 2.6 incisions per
patient (range: 2–6) with the flexor carpi radialis and dorsal distal radius approaches
occurring in 86 and 78% of cases, respectively. One patient was identified as having
a pyogenic granuloma along an incision. However, two patients were identified as having
wound concerns, including fracture blisters (n = 1) and wound margin epidermolysis (n = 1) along the incision. There were no cases of skin bridge necrosis, delayed healing,
wound dehiscence, or infection.
Conclusions There is no increased risk of wound healing complications with the use of multiple
skin incisions (≥2) in the surgical management of distal radius fractures, afforded
by the abundant and robust angiosomes around the wrist. Surgeons should have the confidence
to utilize the necessary number of skin incisions to effectively reconstruct distal
radius fractures.
Keywords
skin incision - distal radius fracture - angiosomes - multiple incisions - wound healing
complications
