title: Experience with proctectomy to manage combat casualties sustaining catastrophic perineal blast injury complicated by invasive mucor soft-tissue infections.
abstract: Catastrophic pelviperineal injuries have become more commonplace on the modern battlefield as a result of dismounted blast mechanism and the survival benefits afforded by far-forward resuscitation and surgery. Inherent in the survival of casualties with such devastating injuries is both the risk for invasive infections and the need for complex reconstruction. We report a series of two combat casualties sustaining the constellation of catastrophic pelviperineal blast injury, anal sphincter complex destruction, complicated by invasive fungal infection managed with completion proctectomy. Our experience, although lacking numbers to qualify as high-level evidence to guide care, will assist future surgeons' care for similar patients.
authors.affiliation: U.S. Army Institute of Surgical Research, 3698 Chambers Pass, Fort Sam Houston, TX 78234.
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: Lundy
authors.affiliation: U.S. Army Institute of Surgical Research, 3698 Chambers Pass, Fort Sam Houston, TX 78234.
authors.forename: Ian R
authors.initials: IR
authors.lastname: Driscoll
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000935:Antifungal Agents / Q000627:therapeutic use; D001753:Blast Injuries / Q000175:diagnosis / Q000601:surgery*; D003646:Debridement; D005107:Explosions; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008889:Military Personnel; D009089:Mucor / Q000302:isolation & purification*; D009091:Mucormycosis / Q000209:etiology* / Q000382:microbiology / Q000628:therapy; D019637:Orthopedic Procedures / Q000379:methods; D010502:Perineum / Q000293:injuries*; D014946:Wound Infection / Q000209:etiology* / Q000382:microbiology / Q000628:therapy
chemical_list: D000935:Antifungal Agents