Catastrophic pelvic-perineal injuries with traumatic hemipelvectomy following a motorcycle collision: a multidisciplinary reconstruction case report.

backgroundCatastrophic pelvic and perineal trauma with associated traumatic hemipelvectomy is extremely rare and carries a high mortality risk. These injuries often involve multisystem destruction, including genitourinary, anorectal, musculoskeletal, and vascular structures, presenting extraordinary challenges for surgical management and reconstruction. Reports of survivors, particularly from resource-limited settings, remain limited. CASE PRESENTATION: A 52-year-old man presented in 2022 with devastating pelvic-perineal trauma following a high-energy motorcycle crash. He received initial first aid at a district hospital before being urgently transferred to our tertiary care center in Vietnam. Upon arrival, he was in profound hemorrhagic shock, with non-palpable pulses and unrecordable blood pressure. Operative findings revealed complete avulsion of the left hemipelvis, severe crush injury of the left lower limb, full-thickness rectal transection, bladder rupture, and complete loss of the external genitalia. He underwent prompt resuscitation, left hemipelvectomy, and fecal and urinary diversion, followed by staged reconstruction. Definitive wound coverage was achieved using a combination of local rotational flap, right profunda artery perforator (PAP) flap, and autologous skin grafting. The patient recovered well and was discharged after 112 days with stable vital signs and functioning urinary and fecal diversion.

conclusionsThis case demonstrates the survivability of catastrophic pelvic-perineal trauma with traumatic hemipelvectomy. It emphasizes the importance of multidisciplinary care, early hemorrhage control and surgical intervention, as well as adaptable reconstruction strategies in low-resource settings. CLINICAL TRIAL NUMBER: Not applicable.