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Combat-Related Hemipelvectomy: 14 Cases, a Review of the Literature and Lessons Learned.

OBJECTIVES
Trauma-related hemipelvectomy is a rare and often fatal injury that poses a number of challenges to the treating surgeon. Our objective was to identify patient and injury characteristics that have proven difficult to treat, and to describe management techniques.


DESIGN
Retrospective review.


SETTING
Level II trauma center.


PATIENTS
Thirteen consecutive patients who underwent 14 combat-related hemipelvectomies between 2001 and 2013.


INTERVENTION
We reviewed our prospective trauma registry, along with the patients' medical records, radiographs, and clinical photographs.


MAIN OUTCOME MEASUREMENTS
Injury severity scores, required surgical procedures, ambulatory status, and bowel and bladder function.


RESULTS
Hemipelvectomy was indicated for insufficient soft tissue coverage, complicated by life-threatening local infection and/or a dysvascular hemipelvis. Five patients underwent resection for angioinvasive fungal infections. All patients sustained a genitourinary injury, with 7 requiring suprapubic catheters and all undergoing diverting colostomy. After a median of 2 years of follow-up, 2 patients had normal urinary continence and 3 regained fecal continence. The surviving patients required a mean of 44 operations. One patient returned to community ambulation.


CONCLUSIONS
This is the largest published series of trauma-related hemipelvectomies. Our lessons learned may benefit civilian surgeons who are confronted with high-energy open injuries to the pelvic girdle. Although the decision to perform hemipelvectomy should not be taken lightly, this procedure can be lifesaving and should be performed in a timely fashion when indicated.


LEVEL OF EVIDENCE
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.