title: Penetrating injury to the buttock: an update.
abstract: Clinical research on penetrating injury to the buttock is sparse and largely limited to case reports and clinical series. The purpose of this paper is to provide a detailed overview of literature of the topic and to propose a basic algorithm for management of penetrating gluteal injuries (PGI). MEDLINE, EMBASE, Cochran, and CINAHL databases were employed. Thirty-seven papers were selected and retrieved for overview from 1,021 records. PGI accounts for 2-3 % of all penetrating injuries, with a mortality rate up to 4 %. Most haemodynamically stable patients will benefit from traditional wound care and selective non-operative management. When gluteal fascia injury is confirmed or suspected, a contrast-enhanced CT-scan provides the most accurate injury diagnosis. CT-scan-based angiography and endovascular interventions radically supplement assessment and management of patients with penetrating injury to the major buttock and adjacent extra-buttock arteries. Immediate life-saving damage-control surgery is indicated for patients with hypovolemic shock and signs of internal bleeding. A universal basic management algorithm is proposed. This overview shows that penetrating injury to the buttock should be regarded as a potential life-threatening injury, and therefore, patients with such injuries should be managed in trauma centres equipped with hybrid operating theatres for emergency endovascular and open surgery for multidisciplinary teams operating 24/7.
authors.affiliation: Emergency General Surgery and Major Trauma Units, Cheshire and Merseyside Major Trauma Centre, Aintree University Hospital NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, UK, raimundas.lunevicius@aintree.nhs.uk.
authors.forename: R
authors.initials: R
authors.lastname: Lunevicius
authors.forename: D
authors.initials: D
authors.lastname: Lewis
authors.forename: R G
authors.initials: RG
authors.lastname: Ward
authors.forename: A
authors.initials: A
authors.lastname: Chang
authors.forename: N E
authors.initials: NE
authors.lastname: Samalavicius
authors.forename: K M
authors.initials: KM
authors.lastname: Schulte
mesh_terms: D002081:Buttocks / Q000293:injuries*; D003952:Diagnostic Imaging; D019468:Disease Management; D014943:Global Health; D006801:Humans; D015994:Incidence; D014193:Trauma Centers; D014950:Wounds, Penetrating / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy