Treatment of combined abdominal and pelvic trauma

Abstract

AIM: To decrease disability and mortality in patients with severe combined pelvic and abdominal trauma via applications of new progressive treatment tactics. MATERIAL AND METHODS: Retrospective and prospective analysis included 1033 patients with severe combined traumas (SCT) who were treated at the Clinical Hospital #3 in 2009-2015. Patients were divided into 2 groups - control (2009-2010) and main (2011-2015) group. Treatment in control group was similar to conventional approaches. In main group severity of injury was determined according to AİS (Abbreviated İnjury Scale) and İSS (İnjury Severity Scale) scales. 'Damage control' principle was applied in these patients. RESULTS: In the main group 'damage control' principle with programmed multi-stage surgical approach was followed by mortality near 36.4% vs. 45.5% in the control group. Any surgical procedures are possible in patients with pelvic injuries type A and ISS score 17-26. In patients with pelvic injuries type A and ISS score 26-40 urgent surgery is advisable along with resuscitative assistance. Emergency surgery is performed for fractures type B and life-saving interventions for fractures type C. These operations are carried out simultaneously with pre- and intraoperative blood transfusion and vital functions stabilization. Life-saving procedures alone may be performed in patients with advanced injury and ISS score 41-49 and up to 75 regardless type of trauma.