Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 May;37(2):247-255.
doi: 10.4266/acc.2021.01396. Epub 2022 Apr 22.

Determination of risk factors associated with surgical site infection in patients undergoing preperitoneal pelvic packing for unstable pelvic fracture

Kang Min Kim  1 , Myoung Jun Kim  2   3   4 , Jae Sik Chung  2   3   4 , Ji Wool Ko  2   3   4 , Young Un Choi  2   3   4 , Hongjin Shim  2   3   4 , Ji Young Jang  5 , Keum Seok Bae  2   3 , Kwangmin Kim  2   3   4
Affiliations

Determination of risk factors associated with surgical site infection in patients undergoing preperitoneal pelvic packing for unstable pelvic fracture

Kang Min Kim et al. Acute Crit Care. 2022 May.

Abstract

Background: Several recent studies have shown that preperitoneal pelvic packing (PPP) effectively produces hemostasis in patients with unstable pelvic fractures. However, few studies have examined the rate of surgical site infections (SSIs) in patients undergoing PPP following an unstable pelvic fracture. The purpose of the present study was to evaluate factors associated with SSI in such patients.

Methods: We retrospectively reviewed the medical charts of 188 patients who developed hemorrhagic shock due to pelvic fracture between April 2012 and May 2021. Forty-four patients were enrolled in this study.

Results: SSI occurred in 15 of 44 patients (34.1%). The SSIs occurred more frequently in cases of repacking during the second-look surgery (0 vs. 4 [26.7%], P=0.010) and combined bladder-urethra injury (1 [3.4%] vs. 4 [26.7%], P=0.039). The incidence of SSIs was not significantly different between patients undergoing depacking within or after 48 hours (12 [41.4%] vs. 5 [33.3%], P=0.603). The mean time to diagnosis of SSI was 8.1±3.9 days from PPP. The most isolated organism was Staphylococcus epidermidis.

Conclusions: Repacking and combined bladder-urethra injury are potential risk factors for SSI in patients with unstable pelvic fracture. Close observation is recommended for up to 8 days in patients with these risk factors. Further, 48 hours after PPP, removing the packed gauze on cessation of bleeding and not performing repacking can help prevent SSI. Additional analyses are necessary with a larger number of patients with the potential risk factors identified in this study.

Keywords: bone fractures; pelvic bone; surgical wound infection.

PubMed Disclaimer

Conflict of interest statement

CONFLICT OF INTEREST No potential conflict of interest relevant to this article was reported.

Figures

Figure 1.
Figure 1.
Patient flowchart. PPP: preperitoneal pelvic packing; SSI: surgical-site infection.
See this image and copyright information in PMC

References

    1. Costantini TW, Coimbra R, Holcomb JB, Podbielski JM, Catalano R, Blackburn A, et al. Current management of hemorrhage from severe pelvic fractures: results of an American Association for the Surgery of Trauma multi-institutional trial. J Trauma Acute Care Surg. 2016;80:717–23. - PubMed
    1. Kim TH, Yoon YC, Chung JY, Song HK. Strategies for the management of hemodynamically unstable pelvic fractures: from preperitoneal pelvic packing to definitive internal fixation. Asian J Surg. 2019;42:941–6. - PubMed
    1. Pohlemann T, Gänsslen A, Bosch U, Tscherne H. The technique of packing for control of hemorrhage in complex pelvis fractures. Tech Orthop. 1995;9:267–70.
    1. Stahel PF, Moore EE, Burlew CC, Henderson C, Peña AJ, Harry D, et al. Preperitoneal pelvic packing is not associated with an increased risk of surgical site infections after internal anterior pelvic ring fixation. J Orthop Trauma. 2019;33:601–7. - PubMed
    1. Smith WR, Moore EE, Osborn P, Agudelo JF, Morgan SJ, Parekh AA, et al. Retroperitoneal packing as a resuscitation technique for hemodynamically unstable patients with pelvic fractures: report of two representative cases and a description of technique. J Trauma. 2005;59:1510–4. - PubMed

LinkOut - more resources