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Traumatic hemipelvectomy: Improvements in the last decennia illustrated by 2 case reports
T K Timmers1, D Tiren, P F Hulstaert
1University Medical Centre Utrecht, Department of Surgery, P.O.-box 85500, 3508 GA Utrecht, The Netherlands.
Introduction:
In this article we present two cases of young men who sustained a traumatic hemipelvectomy.
Presentation Of Case:
The first case occurred more than 10 years ago and the second case happened less than 1 year ago. Changes in the management for resuscitation, surgical intervention, and in postoperative treatment are detailed. Goal of this article is to evaluate the changes over time in the treatment of trauma in general and this specific injury in particular.
Discussion:
Maximum survival chance could be achieved by an aggressive resuscitation (following a massive transfusion protocol-ratio of 1:1:1 unit of blood-products), starting pre-hospitally and continued in the emergency department, immediate control of the haemorrhage and direct surgical intervention. Early and frequent re-explorations are necessary to prevent complications as sepsis and to minimize the chance for complications such as disturbed wound healing and fistula formation. The use of the Vacuum-Assisted Closure therapy nowadays gives the patient an earlier recover and lesser chance at developing complications. Early consultation with plastic surgeons needs to be done in order to achieve an adequate definitive wound-closure (reconstructive surgery).
Conclusion:
A traumatic hemipelvectomy is a catastrophic and mutilating injury, seldom survivable. Maximum survival chance could be achieved by an aggressive resuscitation, frequent re-explorations, the use of VAC therapy and early consultation with a plastic surgeon for reconstructive surgery.
