Pelvic packing

(A) Pelvic packing is performed through a 6-8 cm midline incision made from the pubic symphysis cephalad and the midline fascia is divided.
(B) The pelvic hematoma often dissects the preperitoneal and paravesical space toward the presacral region, thereby facilitating packing. If this has not occuured, blunt digital dissection is performed to open the preperitoneal space.
(C) Three standard surgical laparotomy pads are placed on each side of the bladder deep within the preperitoneal space. If a suprapubic tube is placed, it should exit through a separate stab incision, cephalad to the incision either in the midline or slightly off midline. The midline fascia is closed with a running suture and the skin is reapproximated with staples.