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The deep perineal laceration-an injury frequently associated with open pelvic fractures: a need for aggressive surgical management. A report of 12 cases and review of the literature.

The deep perineal laceration indicates major pelvic injury, especially when associated with pelvic fracture. Survival requires hemostasis, which must be established early by whatever means necessary, including emergency hemipelvectomy if required. Twelve patients with deep perineal laceration are reviewed. Seven patients died. Early deaths were caused by uncontrolled hemorrhage. Late deaths were related to infection in the pelvis. Prompt totally diverting colostomy with irrigation and disimpaction of the defunctionalized rectum and primary repair of urethral injuries are essentials in avoiding septic complications. A technique of rapid totally diverting colostomy that facilitates distal washouts without wound contamination is described.