Complex Perineal Injuries in Blunt Trauma Patients: The Value of a Damage Control Approach

Abstract

ABSTRACT Purpose In a previous work, we presented a protocol for the management of patients with complex pelviperineal injuries (CPI) resulting from blunt trauma. This treatment protocol included: early hemorrhage control, surgical debridement of devitalized tissue, selective loop transverse colostomy according to the location of the perineal wound, distal colonic irrigation with saline solution, pulsatile saline solution irrigation of the perineal wound, maintenance of the perineal wound open, management of bone fractures and visceral injuries, surgical revisions at intervals of 24 to 48 hours, presumptive antibiotic therapy, early nutritional support, and definitive repair of wound defect and visceral injuries after infection control and metabolic recovery. In order to determine whether the evolution of the authors's protocol for the assessment and management of patients with CPI is associated with improved patient outcome we conduct this review. Materials and methods The medical records of 42 patients with CPI resulting from blunt trauma admitted in the level I trauma center at the HC-USPSM, were reviewed. Demographic data, mechanism of trauma, revised trauma score (RTS) and injury severity score (ISS), classification of perineal injuries, associated systemic trauma, infection complications and mortality rates (overall, early and late) were collected. Results The early mortality was 19% and the late mortality was 17%. The overall mortality was 36%. Patients who died had higher average ISS (average ISS = 45) comparing to patients who survived (average ISS = 25) with significant statistical difference (p < 0.05). Damage control principles applied to CPI was the standard of care and a selective approach to perform fecal stream diversion were used. Conclusion The results of this study showed that the use of this protocol was effective and reinforced the importance of the priority in early control of hemorrhage, early fecal diversion in selected cases, multiple surgical perineal revisions, and avoidance of complex visceral injury repair at the first surgical intervention. How to cite this article Teixeira Jr FJR, do Couto Netto SD, Collete e Silva FS, Mori ND, Fontes B, Poggetti RS, Birolini D, Bernini CO, Utiyama EM. Complex Perineal Injuries in Blunt Trauma Patients: The Value of a Damage Control Approach. Panam J Trauma Crit Care Emerg Surg 2015;4(2):87-95.