Arul G S, Bowley D M, DiRusso S
Department of Surgery, UK MTF, Camp Bastion, Afghanistan.
J R Army Med Corps. 2012 Dec;158(4):331-3; discussion 333-4. doi: 10.1136/jramc-158-04-12.
Haemorrhage from severe pelvic fractures can be associated with significant mortality. Modern civilian trauma centres may manage these injuries with a combination of external pelvic fixation, extra-peritoneal packing and/or selective angiography; however, military patterns of wounding are different and deployed medical facilities may be resource constrained. We report two successful instances of pelvic packing using chitosan impregnated gauze (Celox) when conventional surgical attempts at vascular control had failed. We conclude that pelvic packing should be considered early in patients with military pelvic trauma and major haemorrhage, as part of damage control surgery and that Celox gauze may be a useful adjunct. In our cases, the Celox gauze was easily removed after 24-48 hours without significant bowel adhesions and did not leave a residual phelgmon (of exudate or gel) that may predispose to infection.
严重骨盆骨折引起的出血可能导致显著的死亡率。现代民用创伤中心可能会通过外固定骨盆、腹膜外填塞和/或选择性血管造影等综合方法来处理这些损伤;然而,军事创伤模式有所不同,且部署的医疗设施可能资源有限。我们报告了两例在常规手术控制血管失败后,使用壳聚糖浸渍纱布(Celox)进行骨盆填塞成功的案例。我们得出结论,对于军事骨盆创伤和大出血患者,应尽早考虑将骨盆填塞作为损伤控制手术的一部分,且Celox纱布可能是一种有用的辅助材料。在我们的案例中,Celox纱布在24 - 48小时后很容易取出,没有明显的肠粘连,也没有留下可能易引发感染的残余脓肿(渗出物或凝胶)。