First successful complete replantation of a traumatic hemipelvectomy: Follow-up after 30 months

• Published in: Injury Vol. 44; no. 9; pp. 1252 - 1256
• Main Authors: Walcher, Felix, Lustenberger, Thomas, Schmandra, Thomas, Byhahn, Christian, Laurer, Helmut, Bingold, Tobias, Schweigkofler, Uwe, Winckler, Benedikt, Walter, Gerhard, Marzi, Ingo
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.09.2013
• Subjects: Adult; Amputation, Traumatic - surgery; Follow-Up Studies; Fractures, Open - surgery; Germany - epidemiology; Hemipelvectomy; Humans; Male; Multiple Trauma - surgery; Orthopedics; Reconstructive Surgical Procedures - methods; Replantation; Soft Tissue Injuries - surgery; Traumatic hemipelvectomy; Traumatic hindquarter amputation; Germany; Traumatic hindquarter amputation; Replantation; Traumatic hemipelvectomy
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2012.09.025

Summary Traumatic hemipelvectomy is a severe, however rare injury associated with high lethality. Up to now, immediate surgical completion of the amputation has been recommended as a lifesaving therapy. We present a case of near complete hemipelvectomy with open fracture of the ileosacral joint, wide open symphysis and severe soft tissue trauma including a decollement around the pelvis. Successful complete replantation was performed by primary internal stabilisation and revascularisation using vascular grafts. In the further hospital course, numerous revisions of the soft tissue injury and reconstructive surgery were needed. Thirty months later, the patient's condition is physically and psychologically stable and he is able to walk using crutches. The key point of successful management was skilled emergency damage control surgery followed by dedicated surgical care to avoid septic complications.