The use of damage-control principles for penetrating pelvic battlefield trauma

BackgroundHigh-velocity, penetrating pelvic injuries present one of the most difficult challenges to military trauma surgeons. The patients often present in physiologic extremis, and their injury-site patterns frequently include soft tissue, pelvic fractures, genitourinary tract, rectum, vascular structures, and intra-abdominal viscera.MethodsA retrospective review of the 31st Combat Support Hospital damage-control laparotomy database, under an Institutional Review Board–approved protocol, revealed 28 patients with severe multisystem penetrating pelvic injuries. Up to 75 data points were queried for each patient and subjected to descriptive analysis using SPSS 11.0.4 Statistical Software Package (SPSS, Inc, Chicago, IL).ResultsOf 28 patients with severe penetrating pelvic injuries, 43% had extraperitoneal rectal, 43% had urologic, and 50% had major vascular injuries. On average, patients required 4 abdominal operations for treatment of all injuries. Six of 28 (21%) patients died within the first week after injury, and 36% of patients with vascular and rectal injuries died.ConclusionsManagement of these injuries frequently required damage-control techniques and a staged, multidisciplinary approach to reconstruction. Combined rectal and vascular injuries were the most devastating in this type of injury complex.