Retroperitoneal packing as part of damage control surgery in a Danish trauma centre--fast, effective, and cost-effective

Abstract

Background: Retroperitoneal packing in patients with severe haemorrhage is a cornerstone of modern pelvic fracture management. However, few Danish trauma surgeons have experience with this procedure, and trauma audits show that many hesitate to perform the procedure, indicating a need for hands-on training for this simple and potentially lifesaving procedure.

Materials and methods: During a six-month period, trauma surgeons were taught the retroperitoneal packing procedure using human corpses at the Department of Pathology at Aarhus University Hospital.

Results: The course consisted of a 30 minute long single training session in retroperitoneal packing. Twenty-three sessions were held. Forty-two trauma surgeons (the entire staff at Aarhus Trauma Centre) and ten observers completed the course. Afterwards, all participants felt competent to perform the procedure.

Conclusion: All 42 surgeons at our local trauma organisation learned a simple lifesaving operation within a short time period. In the 12 months following the completion of the course, 11 patients were treated with packing without any hesitation and with success. Damage control surgery with packing was cost-effectively implemented at our centre with great ease and rapidity.

Figure 1

Retroperitoneal packing is performed on a human corpse at the Department of Pathology. A midline incision from the umbilicus to the symphysis is made. The abdominal musculature is divided until the peritoneum is reached. From here, it is possible to manually dissect the retroperitoneal space down into the pelvic space along the pelvic bones.

Figure 2

Access to the retroperitoneal space in the left pelvic area is made. The left hand pushes the peritoneum and intestines medial and cranial. Swabs are placed into the newly created space with the right hand. In a living patient, a haematoma would have dissected this space, which is then filled with swabs after the coagulum is removed.

Figure 3

Two or more swabs are placed to pack the left pelvic space. The same procedure is used on the right side. Bilateral packing can be done in one to two minutes.