Trunk and perineal injuries are complex and not-so-common types of injuries. These injuries can happen in road traffic accidents, falls of heavy objects over a person, landslides or construction sites, excavation site landslides, gunshot injuries, assault injuries, or warfare injuries. Whatever the mechanism of injury, these injuries may lead to injury not only of the skin and muscles but also of the ribs, lungs, heart, intraabdominal organs like the bowels, rectum, anus, urinary bladder, vulva, vagina, perineum, scrotum, penis, pelvic bone, hip fractures, or a combination thereof.
Considering the variable patterns and different types of tissues and organs injured, management of these injuries requires the involvement of different specialists including plastic surgeons, general surgeons, thoracic surgeons, urologists, orthopedic surgeons, or gynecologists. Depending upon the injury of the organ, the involvement of a specialist is decided. Plastic surgeon forms an indispensable part of the team whatever the grade and combination of trunk and perineal injuries.
Trunk and perineal injuries may happen due to compression, fall of heavy object, as a penetrating injury in road traffic accidents, gunshot injuries, assaulted injuries or combination of spectrum of injuries in a patient having multiple injuries (polytrauma). There can be varying degree of presentations of these injuries from deep abrasions, degloving of skin, compression injury of chest and abdomen leading to multiple rib fractures and/or internal organ injuries, abdominal organs injuries, injuries of urinary bladder, urethral injury with or without pelvic bone fractures, injuries of perineum including vulva, vagina, scrotum, penis, rectum or anal canal injuries.
Cause of trunk and perineal injuries range widely over different types of accidents. These injuries can happen due to road traffic accidents, landslides, accidents at constructions sites or sites of excavation, collapse and fall of a building, earthquake injuries, fall from height, compression injuries in factories, assaulted injuries or gunshot injuries.
Majority of these injuries are obvious on the surface. However, standard methods of diagnosis must always be followed for any of these injuries. History tells many things and detailed history with actual mode of accident can lead a surgeon in the direction of diagnosis. Physical examination of the patient points towards presence of possible internal organ injuries. Injuries visible on the surface must be noted in details. Confirmation of internal organ injuries and detailed assessment of injured structures require help of radiological diagnostic tools like X – rays, Ultrasonography, C.T. scan or an M.R.I. Angiography is also indicated in certain special situations. Laboratory investigations are required for assessment of hemodynamic status, kidney function, liver function and presence of muscle damage.
Trunk and perineal injuries treatment is a team work. Before deciding upon the definitive treatment and executing the plan, assessment of the general condition of the patient and correction of breathing difficulties, hypovolemia, low hemoglobin levels and systemic stabilization of the patient is of paramount importance. Definitive treatment of these injuries is a team work and formation of the team is decided by detailed assessment and diagnosis of injury and organs involved in the injury.
A team for the management of trunk and perineal injuries can be made of plastic surgeon, general surgeon, thoracic surgeon, orthopedic surgeon, gynecologist or an urologist. Amongst all these team members, plastic surgeon is a constant member of the team who can lead the team and coordinate with other specialists.
Complications of trunk and perineal injuries can be of different variety, same as the injury itself. Minor complications like wound healing problems, deep scarring or skin excoriation are not disabling and can be tackled by good nursing care and attention. However, major complications can happen after such complicated injuries and they can be empyema thoracis (collection of pus in between the layers covering the lungs), lung contusion and consequent decreased oxygenation of blood, malfunctional heart and secondary problems arising out of it, flail chest (improper and asynchronous expansion of chest) due to multiple rib fractures, fecal fistula (leakage of stool from the injured bowels), biliary leakage and associated complications, intraabdominal abscess formation, hernia due to loss of abdominal wall, exposure of heart and/or lungs due to destruction of chest wall, urinary fistula, non-healing wounds over perineum, infection of skin and deep wounds, cellulitis, systemic infection and consequent signs of sepsis are the possibilities of complications.
Prevention of trunk and perineal injuries comprises of establishing and following safety protocols at all levels of accidents which are responsible for these injuries. However, certain minimum fraction of trunk and perineal injuries are bound to happen in spite of all safety protocols. In such circumstances, importance of plastic surgeon and his/her reconstructive skills must be considered and taken in to account while planning and executing the treatment.
Results of treatment for trunk and perineal injuries are encouraging, provided the patient is examined primarily by the concerned specialists including plastic surgeon and the treatment is planned and executed accordingly. However, significant number of these patients are systemically unstable and require intensive care and prolonged admission in I.C.U. for survival. In such patients, chances of complications and associated morbidity are higher and they might have permanent stigma of injury.
Cutis is the best hospital for trunk and perineal injuries because all the patients with any injury (including trunk and perineal injury) are examined primarily by our experienced plastic surgeon at Cutis Hospital. Being a plastic surgeon is in itself a great advantage for such patients and their injury management. Because of his general surgery background and cross-specialty work, a plastic surgeon is the best doctor to form and lead a team of doctors in such situations.
Yes, skin grafting is useful in patients of trunk and perineal injuries. Skin grafting is required in patients with skin loss due to injury. If the injury is not very deep and limited only to skin loss, skin grafting can be done within 48 hours of injury (primary skin grafting) or if injury is extensive and requires multiple dressings, skin grafting is done after few weeks of injury (secondary skin grafting).
Reconstruction of large soft tissue defects can be accomplished by plastic surgical technique of flap reconstruction. These flaps can comprise of skin (skin flaps), muscle 9muscle flaps) or skin and muscle combined (musculocutaneous) flaps.
Not in all cases, but in selected patients, plastic surgery can definitely help improving the perineal scars. In fact, it is always the best policy to involve a plastic surgeon in the treatment of perineal injuries from immediately after the injury.
Definitely, yes. Because plastic surgeon uses loupe magnification for repair of all such injuries and the definitive repair of any injury by a plastic surgeon is always preceded by debridement, the quality of healing and the results of repair of perineal injury by a plastic surgeon exceeds those by any other specialist.
Absolutely no waiting period is preferred. Perineal injuries in a girl child must immediately be repaired by an experienced plastic surgeon after thorough examination and investigations. Repair of perineal injury of a girl child done under anesthesia by a qualified and experienced plastic surgeon under ideal circumstances produces the best long term functional and aesthetic results.
We provide effective surgical and non-surgical treatments for all parts of the body. At Cutis Hospital, our cosmetic and plastic surgery team is committed to giving patients safe and high-quality care.
