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JAMA Clinical Challenge
March 14, 2012

Appearance of a Rapidly Expanding Facial Eschar in a Severely Injured Trauma Patient

Author Affiliations

Author Affiliations: The R Adams Cowley Shock Trauma Center and Division of Plastic, Reconstructive and Maxillofacial Surgery, University of Maryland, Baltimore.

JAMA. 2012;307(10):1080-1081. doi:10.1001/jama.2012.288

A 21-year-old woman presents to the trauma resuscitation unit via helicopter transport following a motor vehicle crash. She was an unrestrained driver involved in a front-end collision and had a prolonged extrication from the vehicle. At the scene, she was unresponsive and underwent emergency intubation. She sustained multiple severe traumatic injuries including a ruptured spleen requiring abdominal exploration and splenectomy, atlanto-occipital dislocation requiring halo placement, bilateral pelvic fractures requiring pelvic binder, and left lower extremity crush injury with multiple open fractures ultimately requiring a left hemipelvectomy. She underwent 38 operative interventions in a 3-week period.