External Iliac artery injury in severe pelvic ring trauma: Limb salvage or early hemipelvectomy? A case series.
Yun-Jung Yang, Chih-Yang Lai, Ping-Jui Tsai et al.
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Case in brief
The authors reviewed five patients with high-energy pelvic ring injuries and associated external iliac artery injuries. All had severe vascular injury and major soft-tissue damage. Revascularization was attempted in two, but limb salvage was unsuccessful in every patient. Despite repeated debridement, four ultimately underwent hemipelvectomy because of progressive necrosis and infection. All five survived after prolonged multidisciplinary treatment. The report highlights that restoring arterial flow did not ensure limb viability when extensive soft-tissue destruction was present.
What made this case unusual
The central challenge was the mismatch between vascular reconstruction and limb outcome: revascularization was attempted in two patients, yet no limb was salvaged, and four patients ultimately required hemipelvectomy.
Diagnostic / clinical pearl
In combined pelvic ring and external iliac artery injury, assess limb viability in the context of soft-tissue destruction and contamination; vascular patency alone does not establish that salvage is achievable.
Why it matters
The authors suggest that recognizing a non-salvageable limb early and considering timely hemipelvectomy may avoid prolonged salvage attempts in selected patients.