PMC7594704_01
Photographs and illustrations of the workplace accident in which a 47-year-old man suffered severe pelvic trauma. A, B, Photographs of the accident scene, showing the patient's left hip and right thigh trapped by the wood processing machine. C, Illustration showing a top view of the accident scene. D, Illustration showing the patient's left foot trapped by the machine. The processing machine can slide on the table.
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HEMS arrived (37 min after injury), the patient's left hip and right thigh were still trapped under the machine (Fig. 1). He was confused and sweating severely but only a small amount of external hemorrhage was noted.
Severe pelvic trauma in a 47-year-old man. Left panel, A deep tear is seen from the right lumbar region to the left thigh, through the groin and perineal area. Arrow, exposed right external iliac artery with a Nelaton catheter tourniquet; arrowhead, exposed left external iliac artery with an arterial access. Right panel, 3-D computed tomography image shows multiple pelvic fractures and bilateral femur fracture.
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A large wound in his right lumbar region and massive bleeding from the perineum to the left thigh were observed (Fig. 2, left). Contrast-enhanced CT was undertaken on the same table after TAE and showed no severe injury except to the pelvis and bilateral lower extremities (Fig. 2, right).
Clinical course timeline from the accident causing severe pelvic trauma in a 47-year-old man. Numbered events with arrowheads are indicated with the legends in the white box. DBP, diastolic blood pressure; HEMS, helicopter emergency medical service; HER, hybrid emergency room; HR, heart rate; OR, operating room; SBP, systolic blood pressure; TAE, transcatheter arterial embolization; Trans, transportation.
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Although the operation was unexpectedly long, the patient's hemodynamics improved during the amputation (Fig. 3, time series of vital signs).
Severe pelvic trauma in a 47-year-old man. Except for part of the right buttock, the pelvic bone and surrounding muscles were totally necrotic.
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The patient had sepsis from extensive necrosis of the pelvic bone and surrounding muscle, and he did not have enough healthy skin to close the wound (Fig. 4).
Photographs of surgical intervention in a 47-year-old man with severe pelvic trauma. Top left panel, Intraoperative photograph taken with the patient in the prone position. The lumbar pedicle is removed and the dura is exposed, ligated, and then cut (arrow). Top right panel, Large vessels are exposed when the necrotic pelvic muscles are mobilized. 1, right common iliac artery; 2, left ureter; 3, left common iliac vein. Bottom panel, Photograph after pelvic resection.
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The L3 lumbar pedicle was removed, and the dura was exposed, ligated, and cut at the L3/4 level (Fig. 5, upper left). The patient was moved to the supine position, and the large vessel was processed (Fig. 5, upper right). Abdominal surgery was then carried out (Fig. 5, lower) which included a colostomy and reconstruction of the urinary tract (reconstructed simple ureterostomy).