Citation

Lesperance K, Martin MJ, Beekley AC, Steele SR. J. Surg. Educ. 2008; 65(1): 61-66.

Affiliation

Department of Surgery, Madigan Army Medical Center, Fort Lewis, Washington.

Copyright

(Copyright © 2008, Association of Program Directors in Surgery, Publisher Elsevier Publishing)

DOI

10.1016/j.jsurg.2007.08.004

PMID

18308283

Abstract

BACKGROUND: Although penetrating gluteal injuries rarely are life-threatening, the risk for concomitant injury to regional anatomic structures warrants additional evaluation. We analyzed factors affecting the management and outcomes of these injuries. METHODS: Retrospective analysis of prospectively collected data from the 31st Combat Support Hospital during Operation Iraqi Freedom over a 16 month period. RESULTS: From 3442 patients, 115 patients (3.3%) suffered penetrating gluteal injuries. They were predominately male (98%) with a mean injury severity score of 13. Mortality was 6% (n = 7). Primary mechanisms of injury were improvised explosive devices (41%) and gunshot wounds (59%). Associated injuries were present in 57% of patients [orthopedic (35%), abdominal (29%), rectal (25%), vascular (21%), genitourinary (14%), pulmonary (11%), sphincter (9%)]. Overall, 76% required surgical management, with 14% developing postoperative complications. In total, 27 patients (24%) required stoma placement. Gunshot wounds were associated with through and through injuries (43% vs 6%, p < 0.01), rectal injury (35% vs 11%, p < 0.05), and stoma placement (32% vs 11%, p < 0.05). Blast injuries were associated with a higher mean transfusion requirement (11 vs 6 units, p < 0.05), increased length of stay (14 vs 9 days, p < 0.05), and traumatic brain injury (24% vs 6%, p < 0.05). Independent predictors of a need for stoma placement were gunshot wounds (odds ratio = 10, p < 0.05) and injury severity score greater than 20 (odds ratio = 27, p < 0.01). CONCLUSIONS: Penetrating gluteal injuries are associated with significant damage to local structures. Gunshot wounds carry a higher risk of injury to the rectum and stoma placement, whereas blast injuries are associated with less local injury and more multisystem trauma.

Language: en