Management of complex perineal soft-tissue injuries

Kenneth A. Kudsk, Matthew A. McQueen, Guy R. Voeller, Mark A. Fox, Eugene C. Mangiante, Timothy Fabian

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Debridement, fecal diversion, and rectal washout have been proposed as the primary therapy for complex perineal lacerations, but, in most series, survivors have a pelvic sepsis rate of 40-80%. In a retrospective study, six of 18 patients sustaining severe perineal lacerations died within the first few hours of injury due to exsanguination from pelvic injuries. The remaining 12 patients underwent sigmoidoscopy, diversion of the fecal stream with irrigation of the distal rectal stump, and radical initial debridement of necrotic soft tissue. Enteral access was obtained in two patients. In the patients with mandatory daily debridement and pulsatile irrigation, no pelvic sepsis occurred. In three patients without daily debridement, pelvic sepsis complicated recovery. The ability of patients to resume oral nutrition was significantly delayed, necessitating total parenteral nutrition in three patients. We conclude that sigmoidoscopy, total diversion of the fecal stream with irrigation of the distal rectal stump, enteral access for feeding, radical initial debridement of necrotic soft tissue, and mandatory daily debridement with pulsatile irrigation optimize recovery from this devastating injury.

Original languageEnglish (US)
Pages (from-to)1155-1160
Number of pages6
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume30
Issue number9
DOIs
StatePublished - Jan 1 1990

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Soft Tissue Injuries
Debridement
Sigmoidoscopy
Sepsis
Lacerations
Wounds and Injuries
Exsanguination
Total Parenteral Nutrition
Enteral Nutrition
Small Intestine
Survivors
Retrospective Studies

All Science Journal Classification (ASJC) codes

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Kudsk, K. A., McQueen, M. A., Voeller, G. R., Fox, M. A., Mangiante, E. C., & Fabian, T. (1990). Management of complex perineal soft-tissue injuries. Journal of Trauma - Injury, Infection and Critical Care, 30(9), 1155-1160. https://doi.org/10.1097/00005373-199009000-00012

Management of complex perineal soft-tissue injuries. / Kudsk, Kenneth A.; McQueen, Matthew A.; Voeller, Guy R.; Fox, Mark A.; Mangiante, Eugene C.; Fabian, Timothy.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 30, No. 9, 01.01.1990, p. 1155-1160.

Research output: Contribution to journalArticle

Kudsk, KA, McQueen, MA, Voeller, GR, Fox, MA, Mangiante, EC & Fabian, T 1990, 'Management of complex perineal soft-tissue injuries', Journal of Trauma - Injury, Infection and Critical Care, vol. 30, no. 9, pp. 1155-1160. https://doi.org/10.1097/00005373-199009000-00012
Kudsk, Kenneth A. ; McQueen, Matthew A. ; Voeller, Guy R. ; Fox, Mark A. ; Mangiante, Eugene C. ; Fabian, Timothy. / Management of complex perineal soft-tissue injuries. In: Journal of Trauma - Injury, Infection and Critical Care. 1990 ; Vol. 30, No. 9. pp. 1155-1160.
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