Gluteal necrosis following pelvic fracture and bilateral internal iliac embolization: Reconstruction using a transposition flap based on the lumbar artery perforators

Gilleard, Onur; Stammers, John; Ali, Farida

doi:10.1016/j.ijscr.2011.11.002

Cited by 7 publications

(6 citation statements)

References 10 publications

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“…37,44,45 However, debates in the literature have focused on the effectiveness of hemorrhage control and consequent complications. 46 –52 In our study, five patients received early TAE, with one of these patients dying. There have also been reports of extensive gluteal necrosis after TAE in severe pelvic fractures.…”

Section: Discussionmentioning

confidence: 95%

“…Open pelvic fractures are rare and account for only 2-4% of all pelvic fractures. 1 In this study, 46 patients with open pelvic fractures were admitted to our trauma center over a 5-year period, averaging less than 1 patient per month. Because of the low incidence of this injury, obtaining high-level evidence is challenging and remains an obstacle to determining optimal treatment protocols.…”

Section: Discussionmentioning

confidence: 99%

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Clinical features and risk factors for mortality in patients with open pelvic fracture: A retrospective study of 46 cases

Qing-shan

Zhang

Zhou

et al. 2020

J Orthop Surg (Hong Kong)

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Background: This study aimed to investigate the clinical features, current management strategies, and outcomes of open pelvic fracture patients. Methods: We performed a retrospective review of data on patients with blunt trauma and open pelvic fractures admitted to our trauma center over a 5-year period (January 2013 to December 2017). Demographic as well as clinical data including injury mechanism, injury severity score (ISS), fracture classifications, transfusion requirements, interventions, length of hospital and intensive care unit (ICU) stay, and prognosis were investigated. Univariate analysis and binary logistic regression were used to identify the risk variables of death. Finally, a brief literature review was performed to understand the current capacity of treatment and prognosis of this type of injury. Results: Forty-six patients (36 male and 10 female) were included in this study, mean age 43.2 ± 14.2 years. The overall mortality rate was 17.4%; 43.5% of the patients were hypotensive (systolic blood pressure (SBP) <90 mmHg) on arrival. The average ISS was 31.7 ± 6.7, and the average packed red blood cell (PRBC) transfusion during the first 24 h was 9.6 ± 7.4 units. Five patients (10.9%) underwent transcatheter arterial embolization in the early stage of management. The average hospital and ICU length of stay were 53.0 ± 37.6 days and 14.3 ± 15.3 days, respectively. Statistically significant differences were found in ISS, PRBC units received with the first 24 h, SBP, lactate and base excess on admission, and mechanism of injury when comparing between the death and the survival groups ( p < 0.05). ISS and lactate on admission were found to be the independent risk factors for mortality. Conclusion: The mortality rate of open pelvic fractures remains high. ISS and lactate on admission were the independent risk factors for mortality. Optimization of the trauma care algorithms for early identification and treatment of this injury could be the key to decreasing mortality.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Clinical features and risk factors for mortality in patients with open pelvic fracture: A retrospective study of 46 cases

Qing-shan

Zhang

Zhou

et al. 2020

J Orthop Surg (Hong Kong)

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“…The barriers to angiography are the ability to manage an unstable patient in the angiography suite, time and resources required for endovascular intervention [27], and concern for skin ischemia/necrosis in the gluteal area which may compromise a surgical incision-needed definitive fracture fixation [28][29][30].…”

Section: Pelvic Ring Fracturesmentioning

confidence: 99%

Trauma to the Pelvis: Injuries to the Rectum and Genitourinary Organs

Posluszny

Branch

et al. 2015

Curr Trauma Rep

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Pelvic trauma is associated with high mortality rates. Blunt pelvic injuries from high-energy mechanisms are often associated with pelvic fractures and injuries to the rectum and genitourinary (GU) tract. In addition, due to close anatomic proximity, penetrating pelvic trauma can injure the bony pelvis, rectum, and GU tract concomitantly. As a result, the assessment and management of pelvic trauma requires a multifaceted approach involving orthopedics, trauma surgery and urology.

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“…Although TAE is one of the most useful modalities for con- ma, it may be associated with various complications, including puncture site hematoma, impotence, iliofemoral embolization, paraparesis, and ischemic necrosis of the bladder wall, gluteal skin, femoral head, gluteal muscle, and colon (6)(7)(8)(9)(10)(11)(12)(13). Super-selective catheterization of injured vessels may be a good option for avoiding complications related to TAE, because the blood flow to adjacent structures can be maintained by selectively embolizing only the injured vessel.…”

Section: Introductionmentioning

confidence: 99%

“…Gluteal muscle necrosis after proximal embolization at the internal iliac artery level is most frequently reported, and its estimated incidence is about 6% (7,8,(10)(11)(12)(13). Surgical wound break down (12), pelvic organ infarction, including colon, ileum, ureter, and rectum (7,9), and neurologic complications, such as lower limb paresis, sacral plexus palsy, and sciatic palsy (9), have also been reported.…”

mentioning

confidence: 99%

Embolization of Trauma-Associated Pelvic Hemorrhage: Feasibility of Super-Selective Catheterization in Heavily Injured Patients as a Damage Control for Life-Threatening Pelvic Bleeding

Park

Yim

Kim

et al. 2016

J Korean Soc Radiol

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Purpose:To determine the efficacy of embolization with super-selective catheterization of the internal iliac arterial branches to treat heavily injured trauma patients with pelvic arterial bleeding. Materials and Methods: A retrospective analysis was performed using the medical records of 37 patients who underwent trans-arterial embolization for trauma-associated pelvic arterial hemorrhage in a regional trauma center between July 2010 and July 2013. In each patient, hemodynamic stability, embolization level, elapsed time for trans-arterial embolization, clinical outcome and embolization-related complications were evaluated. Comparison of elapsed time, and presence of complication was done according to embolization level. Results: Transarterial embolization was conducted in 37 patients. Hemodynamic stability of each patient was classified into hemodynamic stable (n = 9), and unstable (n = 28). Twenty-nine of 37 patients underwent embolization after super-selective catheterization of more than 2nd order branch of internal iliac artery with a microcatheter, and 8 patients underwent proximal internal iliac artery embolization without super-selective catheterization. The mean elapsed procedure time for super-selective embolization (34.76 ± 20.0 minutes) was not significantly longer than proximal internal iliac artery embolization (33.87 ± 16.73 minutes, p = 0.215). Conclusion: Pelvic arterial embolization with super-selective catheterization is a safe and feasible treatment for heavily injured patients with trauma-associated pelvic arterial bleeding.

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Gluteal necrosis following pelvic fracture and bilateral internal iliac embolization: Reconstruction using a transposition flap based on the lumbar artery perforators

Cited by 7 publications

References 10 publications

Clinical features and risk factors for mortality in patients with open pelvic fracture: A retrospective study of 46 cases

Clinical features and risk factors for mortality in patients with open pelvic fracture: A retrospective study of 46 cases

Trauma to the Pelvis: Injuries to the Rectum and Genitourinary Organs

Embolization of Trauma-Associated Pelvic Hemorrhage: Feasibility of Super-Selective Catheterization in Heavily Injured Patients as a Damage Control for Life-Threatening Pelvic Bleeding

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