Genitoperineal injuries associated with the use of an orthopedic table with a perineal posttraction.
BACKGROUND
Surgical treatment of lower extremity fractures commonly involves the use of orthopedic table with perineal post for countertraction. However, prolonged application of the perineal post has been associated with significant complications. We describe our experience in the management of genitoperineal cutaneous injuries associated with the use of a traction table.


METHODS
Six patients with genitoperineal complications attributed to the use of a traction table were treated at our institution over a period of 2 years. The patient's median age was 25 (range, 20-28) years and all had fractures caused by motor vehicle collision. We evaluated the clinical presentation of these perineal injuries, operative time, therapeutic approach, clinical outcomes, and hospitalization time.


RESULTS
The mean operative time of the orthopedic surgery was 318 minutes +/- 128 minutes (range, 185-540). All patients developed a partial-thickness necrotic area involving the perineum and scrotum in 2 days to 15 days (mean, 7 +/- 5.4) after the surgery. Three patients developed infection of the necrotic tissue. All patients underwent surgical debridement 16.5 days +/- 6.5 days (range, 13-29) after the orthopedic surgery and only one debridement procedure was necessary in all cases. A primary wound closure was possible in one case, and in the other cases the wound healed completely by second intention. The mean hospitalization time was 26.3 days +/- 9.7 days (range, 19-44).


CONCLUSIONS
Genitoperineal skin necrosis induced by perineal traction posttable is a morbid complication that demands surgical debridement and prolonged hospitalization for your treatment. There are many procedures available to reduce the risk of this complication that should be used more liberally by the orthopedic surgeons.
Division of Urology, University of São Paulo School of Medicine, São Paulo, Brazil.
Rafael Ferreira
RF
Coelho
Cristiano Mendes
CM
Gomes
Marcos Hideyo
MH
Sakaki
Eduardo
E
Montag
Giuliano B
GB
Guglielmetti
Tarcisio Eloy P
TE
de Barros Filho
Miguel
M
Srougi
D000063:Accidents, Traffic; D000328:Adult; D015331:Cohort Studies; D005500:Follow-Up Studies; D005837:Genitalia, Male / Q000293:injuries*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D009104:Multiple Trauma / Q000175:diagnosis / Q000601:surgery; D009983:Orthopedic Equipment / Q000009:adverse effects; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000379:methods; D010384:Pelvic Bones / Q000293:injuries*; D010502:Perineum / Q000293:injuries*; D018570:Risk Assessment; D012611:Scrotum / Q000293:injuries / Q000503:physiopathology; D013997:Time Factors; D014143:Traction / Q000009:adverse effects* / Q000295:instrumentation; D016896:Treatment Outcome