ROLE OF PROXIMAL DIVERSION

So much experience has been gained with creative use of wound care and VAC dressings (using stoma paste, staplers, Ioban, Lonestar retractor elastics, etc.) as well as fecal management systems, that colostomy can usually be avoided. Colostomy is indicated in DCBI patients with diagnosed rectal injury or massive pelvic disruption/open pelvic fracture with extremely high suspicion for anorectal injuries. There is rarely a need to do a colostomy on the initial operative intervention.