Perineal Wounds
Case 1.
44 year old male struck by a car moving at highway speeds.
Patient presented to ER in hypotensive shock with open perineal wound with a laceration extending into the rectum, an obvious open tibia fracture and open femur fracture.
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Perineal Wounds | |
Pelvic radiographs and CT scan revealed an APC 3 (Tile C) pelvic fracture.
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AP Pelvis |
CT Scan |
A sheet was wrapped around the patient's waist. His blood pressure responded to crystalloid and transfusion, but he remained tachycardic. He was transferred to the angiography suite. His right internal iliac artery was embolized.
He was then taken to the operating room where the general surgery and orthopaedic trauma teams worked concurrently. An exploratory laparotomy was negative. A colostomy was performed. The perineal wound was I & D'd. The open tibia and femur fractures were I & D'd, then stabilized.
The orthopaedic team then carried out ORIF of the disrupted symphysis pubis, and percutaneous stabilization of the R sacroiliac joint.
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AP Pelvis |
Inlet View |
Outlet View |
The urology team replaced the patient's right testicle back into his scrotum - it had displaced up above his pubic rami. The perineal laceration was closed.
The patient underwent multiple I & D's for his open tibia and femur fractures. The tibia was covered with a medial gastroc flap on day 5. Fevers prompted a re-exploration of the perineal wound, but the wound showed no evidence of infection.
About one month after injury, the patient had recurrent fever. An abdominal CT revealed a fluid collection in the right hip.
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Lower Abdominal CT |
This was felt to be an abscess. Surgical exploration revealed dead gluteus medius and minimus muscles, but no pus. The necrotic tissue was debrided, antibiotic beads were placed.
The patient survived, is ambulatory with crutches, and is currently undergoing
rehab.