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Preperitoneal Packing for Pelvic Fracture Bleeding Control: A Human Cadaver Study

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Abstract

Background

Preperitoneal packing (PPP) has been widely accepted as a damage control technique for severe bleeding from pelvic fractures. It is supposed to work by direct compression and tamponade of the bleeding source in the pelvis and it has been suggested to be effective for both venous and arterial bleeding. However, there is little evidence to support its efficacy or the ability to place the laparotomy pads in proximity of the desired location.

Methods

Bilateral PPP was performed on 10 fresh human cadavers, followed by laparotomy and measurements of resultant pad placement in relation to critical anatomic structures.

Results

A total of 20 assessments of laparotomy pad placement were performed. Following completion of PPP, a midline laparotomy was performed to determine proximity and closest distance of the laparotomy pads to sites of potential bleeding in pelvic fractures. In almost all cases, the pad placement was not contiguous with the key anatomic structure with mean placement 3.9 + 1.1 cm from the sacroiliac joint, 3.5 + 1.6 cm from the common iliac artery, 1.1 + 1.2 cm from the external iliac artery, 2.8 + 0.8 cm from the internal iliac artery, and 2.3 + 1.2 cm from the iliac bifurcation. Surgeon experience resulted in improved placement relative to the sacroiliac joint, however the pads still did not directly contact the target point.

Conclusion

This human cadaver study has shown that PPP, even in experienced hands, may not be placed in significant proximity of anatomical structures of interest. The role of PPP needs to be revisited with better clinical or human cadaver studies.

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Authors and Affiliations

  1. Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA

    Elizabeth R. Benjamin

  2. Department of Surgery, University of Kentucky Chandler Medical Center, Lexington, KY, USA

    Zachary Warriner

  3. Department of Surgery, University of Southern California, Los Angeles, CA, USA

    Demetrios Demetriades

  4. LAC+USC Medical Center, IPT, 2051 Marengo Street, C5L100, Los Angeles, CA, 90033, USA

    Demetrios Demetriades

Authors
  1. Elizabeth R. Benjamin
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  2. Zachary Warriner
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  3. Demetrios Demetriades
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Correspondence to Demetrios Demetriades.

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Benjamin, E.R., Warriner, Z. & Demetriades, D. Preperitoneal Packing for Pelvic Fracture Bleeding Control: A Human Cadaver Study. World J Surg 47, 621–626 (2023). https://doi.org/10.1007/s00268-022-06859-5

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  • DOI: https://doi.org/10.1007/s00268-022-06859-5

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