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J Reconstr Microsurg 2015; 31(01): 012-019
DOI: 10.1055/s-0034-1386616
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Modified Classification and Repair of Perineal Soft Tissue Injuries Associated with Open Pelvic Fractures

Guo Fu
1   Department of Microsurgery and Trauma Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
,
Dong Wang
1   Department of Microsurgery and Trauma Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
,
Bengang Qin
1   Department of Microsurgery and Trauma Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
,
Jianping Xiang
1   Department of Microsurgery and Trauma Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
,
Jian Qi
1   Department of Microsurgery and Trauma Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
,
Ping Li
1   Department of Microsurgery and Trauma Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
,
Qingtang Zhu
1   Department of Microsurgery and Trauma Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
,
Xiaolin Liu
1   Department of Microsurgery and Trauma Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
,
Jiakai Zhu
1   Department of Microsurgery and Trauma Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
,
Li-Qiang Gu
1   Department of Microsurgery and Trauma Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
› Author Affiliations
Further Information

Publication History

08 January 2014

23 February 2014

Publication Date:
16 September 2014 (online)

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Abstract

Background This study describes a modified classification and management protocol for perineal soft tissue injuries associated with pelvic fractures.

Methods A total of 11 patients with perineal soft tissue injuries associated with open pelvic fractures were studied retrospectively. The patients were classified into three types based on the area of defect: type A (urogenital zone), type B (anal zone), and type C (both urogenital and anal zones). Each type included the following subclasses: A1 (without urethra injuries), A2 (with urethra injuries), B1 (without anorectal injuries), B2 (with anorectal injuries), C1 (with types A1 and B1), C2 (with types A2 and B1), C3 (with types A1 and B2), and C4 (with types A2 and B2). The management protocol was planned according to the individual classifications. Protocol A1 (for type A1) involved skin graft or myocutaneous flap transplantation. Protocol A2 (for type A2) involved the same protocol combined with urine diversion. Protocol B1 (for type B1) involved skin graft or myocutaneous flap transplantation. Protocol B2 (for type B2) involved the same management combined with fecal diversion. Protocol C involved the correspondent protocol used for each subtype of type C.

Results Out of the 11 patients, there were 5, 3, and 3 cases of types A, B, and C, respectively. One patient died due to sepsis, and the wounds of the remaining patients healed well. No anal incontinence had occurred.

Conclusions Perineal soft tissue injuries associated with pelvic fractures can be classified into three types, and the management protocol can be planned according to the classification.

Keywords

open pelvic fractures - soft tissue injuries - classification

Both Drs Guo Fu and Dong Wang contributed to the article equally.


 

  • References

  • 1 Grotz MR, Allami MK, Harwood P, Pape HC, Krettek C, Giannoudis PV. Open pelvic fractures: epidemiology, current concepts of management and outcome. Injury 2005; 36 (1) 1-13
    CrossrefPubMedGoogle Scholar
  • 2 Black EA, Lawson CM, Smith S, Daley BJ. Open pelvic fractures: the University of Tennessee Medical Center at Knoxville experience over ten years. Iowa Orthop J 2011; 31: 193-198
    PubMedGoogle Scholar
  • 3 Hanson PB, Milne JC, Chapman MW. Open fractures of the pelvis. Review of 43 cases. J Bone Joint Surg Br 1991; 73 (2) 325-329
    PubMedGoogle Scholar
  • 4 Mohanty K, Musso D, Powell JN, Kortbeek JB, Kirkpatrick AW. Emergent management of pelvic ring injuries: an update. Can J Surg 2005; 48 (1) 49-56
    PubMedGoogle Scholar
  • 5 Durrant JJ, Ramasamy A, Salmon MS, Watkin N, Sargeant I. Pelvic fracture-related urethral and bladder injury. J R Army Med Corps 2013; 159 (Suppl. 01) i32-i39
    CrossrefPubMedGoogle Scholar
  • 6 Lunsjo K, Abu-Zidan FM. Does colostomy prevent infection in open blunt pelvic fractures? A systematic review. J Trauma 2006; 60 (5) 1145-1148
    CrossrefPubMedGoogle Scholar
  • 7 Brenneman FD, Katyal D, Boulanger BR, Tile M, Redelmeier DA. Long-term outcomes in open pelvic fractures. J Trauma 1997; 42 (5) 773-777
    CrossrefPubMedGoogle Scholar
  • 8 Labler L, Trentz O. The use of vacuum assisted closure (VAC) in soft tissue injuries after high energy pelvic trauma. Langenbecks Arch Surg 2007; 392 (5) 601-609
    CrossrefPubMedGoogle Scholar
  • 9 Ozer MT, Coskun AK, Ozerhan IH , et al. Use of vacuum-assisted closure (VAC™) in high-energy complicated perineal injuries: analysis of nine cases. Int Wound J 2011; 8 (6) 599-607
    CrossrefPubMedGoogle Scholar
  • 10 Milcheski DA, Zampieri FM, Nakamoto HA, Tuma Jr P, Ferreira MC. Negative pressure wound therapy in complex trauma of perineum. Rev Col Bras Cir 2013; 40 (4) 312-317
    CrossrefPubMedGoogle Scholar
  • 11 Agel J, Evans AR, Marsh JL , et al. The OTA open fracture classification: a study of reliability and agreement. J Orthop Trauma 2013; 27 (7) 379-384 , discussion 384–385
    CrossrefPubMedGoogle Scholar
  • 12 Bircher M, Eng FE, Hargrove R. Is it Possible to Classify Open Fractures of the Pelvis?. Eur J Trauma 2004; 30 (2) 74-79
    CrossrefPubMedGoogle Scholar
  • 13 Pennal GF, Tile M, Waddell JP, Garside H. Pelvic disruption: assessment and classification. Clin Orthop Relat Res 1980; (151) 12-21
    PubMedGoogle Scholar
  • 14 Faringer PD, Mullins RJ, Feliciano PD, Duwelius PJ, Trunkey DD. Selective fecal diversion in complex open pelvic fractures from blunt trauma. Arch Surg 1994; 129 (9) 958-963 , discussion 963–964
    CrossrefPubMedGoogle Scholar
  • 15 Jones AL, Powell JN, Kellam JF, McCormack RG, Dust W, Wimmer P. Open pelvic fractures. A multicenter retrospective analysis. Orthop Clin North Am 1997; 28 (3) 345-350
    CrossrefPubMedGoogle Scholar
  • 16 Agel J, Rockwood T, Barber R, Marsh JL. Potential predictive ability of the orthopedic trauma association open fracture classification. J Orthop Trauma 2014; 28 (5) 300-306
    CrossrefPubMedGoogle Scholar
  • 17 Wilson RF. Current status of advanced trauma life support training. Ann Emerg Med 1981; 10 (4) 226-227
    CrossrefPubMedGoogle Scholar
  • 18 Argenta LC, Morykwas MJ. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg 1997; 38 (6) 563-576 , discussion 577
    CrossrefPubMedGoogle Scholar
  • 19 Qu J, Yan R, Wang L , et al. Free dermatoplasty combined with vacuum sealing drainage for the treatment of large-area soft tissue defects accompanied by bone exposure in the lower leg. Exp Ther Med 2013; 5 (5) 1375-1380
    PubMedGoogle Scholar
  • 20 Dente CJ, Feliciano DV, Rozycki GS , et al. The outcome of open pelvic fractures in the modern era. Am J Surg 2005; 190 (6) 830-835
    PubMedGoogle Scholar
  • 21 Duchesne JC, Bharmal HM, Dini AA , et al. Open-book pelvic fractures with perineal open wounds: a significant morbid combination. Am Surg 2009; 75 (12) 1227-1233
    PubMedGoogle Scholar
  • 22 Kottmeier SA, Wilson SC, Born CT, Hanks GA, Iannacone WM, DeLong WG. Surgical management of soft tissue lesions associated with pelvic ring injury. Clin Orthop Relat Res 1996; (329) 46-53
    PubMedGoogle Scholar
  • 23 Sinnott R, Rhodes M, Brader A. Open pelvic fracture: an injury for trauma centers. Am J Surg 1992; 163 (3) 283-287
    CrossrefPubMedGoogle Scholar
  • 24 Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma 1984; 24 (8) 742-746
    CrossrefPubMedGoogle Scholar
  • 25 Gustilo RB. Management of open fractures. An analysis of 673 cases. Minn Med 1971; 54 (3) 185-189
    PubMedGoogle Scholar
  • 26 Orthopaedic Trauma Association: Open Fracture Study Group. A new classification scheme for open fractures. J Orthop Trauma 2010; 24 (8) 457-464
    PubMedGoogle Scholar
  • 27 Woods RK, O'Keefe G, Rhee P, Routt Jr ML, Maier RV. Open pelvic fracture and fecal diversion. Arch Surg 1998; 133 (3) 281-286
    CrossrefPubMedGoogle Scholar
  • 28 Ghanayem AJ, Wilber JH, Lieberman JM, Motta AO. The effect of laparotomy and external fixator stabilization on pelvic volume in an unstable pelvic injury. J Trauma 1995; 38 (3) 396-400 , discussion 400–401
    CrossrefPubMedGoogle Scholar
  • 29 Richardson JD, Harty J, Amin M, Flint LM. Open pelvic fractures. J Trauma 1982; 22 (7) 533-538
    PubMedGoogle Scholar
  • 30 Mangiante EC, Graham AD, Fabian TC. Rectal gunshot wounds. Management of civilian injuries. Am Surg 1986; 52 (1) 37-40
    PubMedGoogle Scholar
  • 31 Kumar BA, Chojnowski AJ. Open pelvic fractures with vaginal laceration: an unusual clinical feature. Injury 2000; 31 (1) 68-70
    PubMedGoogle Scholar
  • 32 Mundy AR, Andrich DE. Pelvic fracture-related injuries of the bladder neck and prostate: their nature, cause and management. BJU Int 2010; 105 (9) 1302-1308
    CrossrefPubMedGoogle Scholar