PDF(Pubmed)
Abstract：
This case report explores the management of a traumatic hemipelvectomy-a rare and devastating injury characterized by a high mortality rate. The patient, a 12-year-old male, suffered right lower extremity amputation and right hemipelvectomy due to a deglov-ing injury from a non-vehicle-related accident at another institution. Initially, an urgent reconstruction of the right pelvic region and suprapubic tissue defects was performed using a posterior-based fasciocutaneous flap. Following this, the patient was transferred to the pediatric intensive care unit at our hospital with a suspected diagnosis of necrotizing fasciitis. Treatment included broad spectrum antibiotics and multiple debridements to avert the onset of sepsis. Eventually, reconstruction of a 60 x 25 cm defect covering the lower back, abdomen, gluteal, and pubic regions was achieved through serial split-thickness skin grafts and a pedicled anterolateral thigh flap. The patient made a remarkable recovery, regained mobility with the aid of a walker, and was discharged in good health 22 weeks after the initial accident. This case report underscores the importance of serial debridements in preventing sepsis, the use of negative pres-sure vacuum dressing changes, the initiation of broad-spectrum antibiotics based on culture results during debridements, and prompt closure of the defect to ensure survival after traumatic hemipelvectomy. Familiarization with the principles discussed here is crucial to minimizing mortality rates and optimizing outcomes for this rare injury.
摘要：
此病例报告探讨了创伤性半骨盆切除术的处理方法，这是一种罕见且破坏性的损伤，其特征是死亡率高。病人,一个12岁的男性,由于在另一家机构发生的非车辆相关事故造成的deglov-ing伤害，因此遭受了右下肢截肢和右半骨盆切除术。最初，使用后基筋膜皮瓣对右骨盆区域和耻骨上组织缺损进行了紧急重建。在此之后,该患者被转移到我们医院的儿科重症监护室，怀疑诊断为坏死性筋膜炎。治疗包括广谱抗生素和多次清创以避免败血症的发作。最终,重建一个60×25厘米的缺陷覆盖下背部，腹部，臀肌,耻骨区域是通过连续的分层厚度皮肤移植物和带蒂的股前外侧皮瓣实现的。病人恢复得很好,在助行器的帮助下恢复了机动性，并在初次事故发生22周后健康出院。该病例报告强调了连续清创在预防脓毒症中的重要性。使用负压力真空敷料的变化，根据清创期间的培养结果启动广谱抗生素，并及时闭合缺损以确保创伤性半盆切除术后的生存。熟悉这里讨论的原则对于最小化死亡率和优化这种罕见损伤的结果至关重要。
