Page 39 - Journal of Special Operations Medicine - Fall 2017

Table 2 Steps Followed in Creating a CTB, Using a Standard-Issue
PCS Trouser
Step Description (relating to Figure 4)
Standard-issue PCS trousers were placed onto the cadaver
1 (Figure 4a). Figure 6 Example of the
Anterolateral aspects of the trouser legs are cut superiorly CTB on a live volunteer,
without instrumentation.
2 to the level of the greater trochanters, leaving a free fabric
previously covering the legs.
The free fabric is laid out laterally from the patient
3
(Figure 4b).
The free flaps of fabric are wrapped around the around the
4 pelvis at the level of the greater trochanters and tension is
applied circumferentially (Figure 4c). After each intervention, it was noted that the pressures ob-
The lower leg ties are used to secure the tensioned fabric in tained would peak and then level off at a steady pressure. It
5
place, securing the binder (Figure 4d). was thought the steady pressures achieved would provide a
Pressure measurements are then taken with the manometer more accurate measure of the effect of each intervention and,
6
via the suprapubic incision (Figure 5d). therefore, these pressures were used for the statistical analysis.
Figure 4 Illustration of Steps Followed in Creating a CTB, Using a
Standard-Issue PCS Trouser. Results
Six cadavers were used for this phase of the study; baseline
pressure before any intervention was 8cmH O. The Shapiro-
2
Wilk test of normality was applied to both data sets. Combat
trousers were normally distributed. TPOD pressure measure-
ments were not normally distributed.

After application of CTB, the median, mean (standard error
[SE]) and range of the steady intrapelvic pressures obtained
were 16, 18 (SE, 3), and 11–28cmH O, respectively. A paired
2
t test confirmed that these pressure increases over the baseline
were statistically significant (p < .01).

After application of the TPOD device, the median, mean (SE),
and range of the steady intrapelvic pressures obtained were
18, 24 (SE, 5), and 17–49cmH O, respectively. A Wilcoxon
2
rank-sum test confirmed that these pressure increases over the
Figure 5 Counterclockwise from top left: (A) anterolateral aspects baseline were significant (p < .036).
of the PCS trousers legs are cut superiorly to the level of the greater
trochanters. (B) The free fabric is laid out laterally from the specimen. There was no statistically significant difference, using the Wil-
(C) The free flaps are wrapped around the pelvis, tension is applied coxon rank-sum test, in intrapelvic pressures between the two
circumferentially, and secured with leg ties. (D) Pressure measurements
are then taken with the manometer via the suprapubic incision. interventions (p > .05). All data are presented in Figure 7.
Figure 7 Study results showing median values (black horizontal
lines), interquartile ranges (yellow), and mean values (×) comparing
the effect of the CTB and the TPOD on intrapelvic pressure at
equilibrium compared with baseline. The whiskers extend to the
maximum and minimum values in the data set.

The peak initial pressure was recorded for the CTB at
33.5cmH O, which dropped to the steady pressure, where it
2
remained. There was no further change in intrapelvic pressure
Combat Trousers as Improvised Pelvic Binders | 37