Preperitoneal pelvic packing

(A) The anterior bar of the external fixator should be rotated to permit adequate exposure for the pelvic space incision; it may be located high (near the umbilicus as shown) if only pelvic packing is performed or low (below the symphysis) if both laparotomy and pelvic packing are anticipated.
(B) The midline subcutaneous tissue and fascia are divided either sharply or using electrocautery; a Kelly clamp can help define the planes for division.
(C,D) If required, the suprapubic tube should be brought out through a separate stab incision (C) to prevent egress of the pelvic hematoma through the midline (D).
​(E) Following packing, the midline fascia is closed using a running monofilament suture.
(F) Laparotomy and pelvic packing incisions must be kept separate to prevent decompression of the pelvic hematoma into the abdomen, which precludes effective tamponade.