[Abstract] Objective To introduce the application and preliminary clinical effect of Zhang's suturing technique in high tension incision of Pilon fracture. Methods From 2019 to 2022,11 cases of Pilon fracture were treated with Zhang's hypertonic suture through high tension incision. The insertion points were arranged on both sides of the incision with an axial distance of about 1cm, and the starting and ending points were located at the ends of the lengthening line of the incision with a distance of about 1cm from the incision. The needle was inserted vertically from one end of the incision to the subcutaneous tissue, dermis and epidermis, and then from the same point to the surface of the skin, after passing through the epidermis, dermis, subcutaneous tissue and pulling the skin tissue properly, the pit was formed on the skin surface and sutured continuously to the other end of the incision to tie the knot subcutaneously at the end point. Results All the incisions were closed in one stage, 10 of the 11 cases were healed, 1 case was not healed, and no infection and flap necrosis were found. Follow-up ranged from 3 to 18 months, with an average of 13.5 months. The average pain score was 1.7 at the 14th day after operation. At the last follow-up, the AOFAS score was excellent in 8 cases, good in 2 cases and fair in 1 case. Conclusion Zhang's hypertonic suture can close the incision of high tension Pilon fracture in one stage, and can effectively reduce the incision complications.To explore the application of Zhang's super tension-relieving suture for high tension incision of Pilon fracture and summarize the experience of treatment.