Abstract
Traumatic hemipelvectomy is an uncommon and life threatening injury. We report a case of a 16-year-old boy involved in a traffic accident who presented with an almost circumferential pelvic wound with wide diastasis of the right sacroiliac joint and symphysis pubis. The injury was associated with complete avulsion of external and internal iliac vessels as well as the femoral and sciatic nerves. He also had ipsilateral open comminuted fractures of the femur and tibia. Emergency debridement and completion of amputation with preservation of the posterior gluteal flap and primary anastomosis of the inferior gluteal vessels to the internal iliac artery stump were performed. A free fillet flap was used to close the massive exposed area. traumatic hemipelvectomy, amputation, and free gluteus maximus fillet flap.
Highlights
Traumatic hemipelvectomy is a life threatening injury that requires rapid resuscitation, early surgical intervention and intensive care monitoring
Controversies exist regarding whether to close or leave the primary amputation wound open and the method of soft tissue covering 2. This case highlights a complex injury of hemipelvectomy whereby emergency completion of amputation followed by re-vascularisation of the gluteus flap to cover the massive defect in a single stage surgery
Fig 2b: A completely healed traumatic hemipelvectomy wound covered with free gluteus maximus fillet flap
Summary
Traumatic hemipelvectomy is a life threatening injury that requires rapid resuscitation, early surgical intervention and intensive care monitoring. Improvements in early surgical care have resulted in an increase in the survival rate following this devastating injury 1. Controversies exist regarding whether to close or leave the primary amputation wound open and the method of soft tissue covering 2. This case highlights a complex injury of hemipelvectomy whereby emergency completion of amputation followed by re-vascularisation of the gluteus flap to cover the massive defect in a single stage surgery
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