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Preperitoneal Packing for Pelvic Fracture Bleeding Control: A Human Cadaver Study
Elizabeth R Benjamin1, Zachary Warriner2, Demetrios Demetriades3,4
1Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.
World Journal of Surgery
|December 19, 2022
Summary
Preperitoneal packing (PPP) for pelvic fracture bleeding may not effectively place pads near bleeding sources, even with experienced surgeons. Further studies are needed to confirm the efficacy of this damage control technique.
Area of Science:
- Trauma Surgery
- Anatomy
- Surgical Techniques
Background:
- Preperitoneal packing (PPP) is a damage control method for severe pelvic fracture bleeding.
- It is believed to tamponade venous and arterial bleeding but lacks strong evidence.
- Concerns exist regarding the precise placement and efficacy of laparotomy pads in PPP.
Purpose of the Study:
- To evaluate the anatomical placement accuracy of laparotomy pads during preperitoneal packing in human cadavers.
- To assess the proximity of placed pads to critical bleeding structures in pelvic fractures.
Main Methods:
- Bilateral preperitoneal packing was performed on 10 fresh human cadavers.
- Midline laparotomy was conducted post-packing to measure pad placement relative to key anatomical structures.
- 20 assessments of pad placement were conducted, measuring distances to potential bleeding sites.
Main Results:
- Laparotomy pads were consistently not contiguous with critical anatomical structures targeted for bleeding control.
- Mean distances from pads to key structures ranged from 1.1 to 3.9 cm.
- While surgeon experience improved placement near the sacroiliac joint, direct contact with target points was not achieved.
Conclusions:
- Preperitoneal packing, even by experienced surgeons, may not achieve accurate placement near relevant anatomical structures.
- The clinical role and efficacy of preperitoneal packing require further investigation through robust clinical trials or human cadaver studies.
