Use of anterolateral thigh flap for reconstruction of traumatic bilateral hemipelvectomy after major pelvic trauma: a ca
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CASE REPORT
Use of anterolateral thigh flap for reconstruction of traumatic bilateral hemipelvectomy after major pelvic trauma: a case report Saleh Al‑wageeh1 , Faisal Ahmed2* , Khalil Al‑naggar3 , Mohammad Reza Askarpour4 and Ebrahim Al‑shami5
Abstract Background: Major pelvic trauma (MPT) with traumatic hemipelvectomy (THP) is rare, but it is a catastrophic health problem caused by high-energy injury leading to separation of the lower extremity from the axial skeleton, which is associated with a high incidence of intra-abdominal and multi-systemic injuries. THP is generally performed as a lifesaving protocol to return the patient to an active life. Case report: A 12-year male patient exposed to major pelvic trauma with bilateral THP survived the trauma and mul‑ tiple lifesaving operations. The anterolateral thigh flap is the method used for wound reconstruction. The follow-up was ended with colostomy and cystostomy with wheelchair mobilization. To the best of our knowledge, there have been a few bilateral THP reports, and our case is the second one to be successfully treated with an anterolateral thigh flap. Conclusion: MPT with THP is the primary cause of death among trauma patients. Life-threatening hemorrhage is the usual cause of death, which is a strong indication for THP to save life. Keywords: Amputation, Hemipelvectomy, Myocutaneous flap, Reconstruction, Trauma Introduction Major pelvic trauma (MPT) associated with traumatic hemipelvectomy (THP) was described first by Turnbull in 1978 [1]. Although rare, it is a catastrophic health problem caused by high-energy injury leading to separation of the lower extremity from the axial skeleton from two joints [the symphysis pubis and the sacroiliac (SI) joint]. It is either incomplete (when a soft tissue still attaches the limb) or complete when the limb is separated without any soft-tissue attachment. These injuries are considered massive pelvic injuries [2]. *Correspondence: [email protected] 2 Department of Urology, Urology Research Center, Al-Thora General Hospital, Ibb University of Medical Science, Alodine Street, Ibb, Yemen Full list of author information is available at the end of the article
A few victims survive these injuries, and the actual incidence is unknown, but it is usually underestimated [3]. Massive bleeding (approximately 3–4 L) can occur before the venous tamponade’s effect, especially if there is significant pubic symphysis diastasis. Complex pelvic fractures are associated with a high incidence of intraabdominal injuries (30%) and multisystem trauma (80%), determining the outcome of these injuries [4]. The primary associated intra-abdominal injuries are bladder and urethral injuries, and less common injuries include injuries to the liver, small bowel, spleen, and diaphragm [4]. Initial goals of management include control of life-threatening hemorrhage and patient stabilization followed by thorough debridement of the wound. All devitalized soft tissues must be excised sharply [2]. Conversely, viable muscle and fascioc
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