Survival Against the Odds: Successful Treatment of Incomplete Traumatic Hemipelvectomy in a 29-Year-Old Woman Following a Boating Accident

Traumatic hemipelvectomy (THP) is a rare, life-threatening injury characterized by the dislocation of the hemipelvis, often resulting from high-energy trauma. It carries a high mortality risk due to severe vascular injuries, with survival contingent on rapid hemorrhage control and a multidisciplinary approach. Limb salvage is rarely achievable due to the extent of the injury and complications such as infection and tissue nonviability. We present a case of incomplete THP in a 29-year-old woman who sustained severe soft tissue, bony, and vascular injuries following a boating accident. On arrival, the patient was in critical condition with a massive hemorrhage, requiring immediate intervention. A multidisciplinary approach was implemented, including damage control surgery, vascular ligation, massive transfusion protocol (MTP), and selective embolization. Despite initial efforts, her left lower extremity was deemed unsalvageable, and a left hemipelvectomy was performed. Postoperative care involved managing pedicle flap congestion with sequential wound debridement and hyperbaric oxygen therapy. The patient's recovery included multiple surgical interventions for wound care and flap viability. Over time, viable tissue demarcation allowed for more definitive closure. This case underscores the complexity of managing THP, highlighting the importance of timely, coordinated surgical efforts, aggressive hemorrhage control, and postoperative care to prevent infection and optimize functional outcomes.