Moreover, the patient had a perineal laceration and slight bleeding. The range of motion (ROM) of both hip and knee joints was within the normal range. Initial laboratory examination showed a hemoglobin level of 11.7 and a hematocrit of 35.1. Initial radiographs revealed the presence of a fracture of the left anterior superior iliac spine as well as fractures of the right superior and inferior pubic rami. Computed tomography (CT) scans showed that the patient had a hematoma in the paravesical, prevesical retroperitoneum and subcutaneous emphysema in the left pelvic region (Figure 1). The patient received conservative management, including absolute bed rest and

pain control, at the department of orthopedic surgery of our medical institution. On day 3, the patient’s hemoglobin and hematocrit A-1210477 mw levels had decreased to 6.8 and 20.2, respectively. In addition, the patient showed an increase in the amount of retroperitoneal hematoma on follow-up CT scans. Although this finding might have been due to preexisting pelvic fractures, the patient showed no other internal organ damage and continually Selleck XAV 939 received conservative management after transfusion with 2 pints of packed red blood cells (RBCs). On day 4, the patient exhibited

darkish skin color changes and necrosis in the left gluteal region (Figure 2). At this point, the patient was referred to us for further evaluation and treatment. The patient was suspected of having MLL, for which we followed conservative management with silvadene occlusive dressing until a demarcation of necrotic skin was achieved. On day 9, although the patient showed a decrease in the amount of retroperitoneal hematoma on follow-up CT scans, hematoma or fluid collection was identified in the space between the subcutaneous area and the fascia. Based on these findings,

we established a diagnosis of MLL in our patient (Figure 3). On day 10, the patient displayed a necrotic skin demarcation indicating the boundary between the necrotic and viable areas. The patient underwent partial escharectomy, which resulted in natural Thalidomide drainage of the subcutaneous fluid. The fluid was CBL0137 ic50 serous and did not show any signs of infection. On day 13, the patient underwent debridement of a thick eschar 12 × 10 cm in size (Figure 4) under general anesthesia accompanied by the application of a vacuum-assisted closure (VAC) device for the purpose of promoting the growth of healthy granulation tissue. These maneuvers were repeated three times until day 23. Thus, the patient achieved resolution of the pocket under the wound margin as well as formation of healthy granulation tissue. On day 24, the patient underwent a split-thickness skin graft (STSG), through which successful coverage of the skin defect was achieved. At 6-month follow-up, the patient displayed complete cure of the wound without recurrence of fluid collection (Figure 5).