CONSIDERATION OF LATERAL OR PRONE POSITIONING

In most patients, the posterior soft tissue injuries can be addressed with elevation of the amputated stumps or with the patient in a lateral position after the supine portion of the case has been completed. However, certain injury patterns have a large posterior element. In these cases, prone or lateral positioning is sometimes necessary, after hemorrhage control, to adequately debride wounds in the gluteal and low back region. This decision should not be made lightly, due to the time requirements and risks involved. This can often be deferred to secondary procedures. Lateral positioning is preferred as it allows for easier airway control, but the latter may be needed for complex bilateral lower extremity and truncal wounds. A Jackson table can facilitate a safe transition to the prone position. Unstable pelvic ring injuries should be stabilized prior to prone positioning, as this position can exacerbate hemorrhage.