Traumatic hemipelvectomy: an appeal for primary completion

Area of Science:

• Trauma Surgery
• Orthopedic Surgery
• Emergency Medicine

Background:

• Traumatic hemipelvectomy (TH) represents a rare, life-threatening pelvic injury with high mortality.
• Management challenges include severe pelvic fractures, associated injuries, and potential exsanguination.
• Existing literature primarily focuses on survivors, lacking comprehensive treatment guidelines.

Purpose of the Study:

• To outline aggressive, standardized damage-control strategies for managing traumatic hemipelvectomy.
• To provide recommendations for surgical management, including limb salvage versus completion of hemipelvectomy.
• To address critical aspects of resuscitation, vascular repair, and soft-tissue management.

Main Methods:

• Review of current literature and case series on traumatic hemipelvectomy.
• Emphasis on standardized damage-control procedures in prehospital, emergency room, and initial surgical phases.
• Discussion of massive transfusion protocols, vascular injury management, and colostomy considerations.

Main Results:

• Aggressive initial treatment is crucial to prevent exsanguination and contamination.
• Massive transfusion protocols are vital for managing traumatic coagulopathy.
• Primary completion of hemipelvectomy is often favored over limb salvage due to lower complication rates and better functional outcomes in specific cases (critical ischemia, sacral plexus injury).

Conclusions:

• Standardized damage-control resuscitation is paramount for patients with traumatic hemipelvectomy.
• Early surgical intervention should focus on preventing exsanguination and contamination.
• Completion of hemipelvectomy is recommended in cases of critical ischemia and significant sacral plexus injury to improve outcomes.