Management of a large traumatic hemipelvectomy defect following a truck crush injury: a case report.

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.