High-Energy Trauma with Simultaneous Craniofacial, Cervical, Thoracic and Abdominal Injuries: Development of a Global Sequential Surgery Protocol Based on Evidence Derived from an Exceptional Case
DOI:
https://doi.org/10.70577/asce.v5i3.1064Keywords:
High-energy trauma; polytrauma; craniofacial injuries; damage control surgery; sequential surgery; multidisciplinary protocol.Abstract
High-energy trauma simultaneously affecting the craniofacial, cervical, thoracic, and abdominal regions constitutes one of the most complex clinical scenarios in trauma surgery. Multisystem injuries trigger a pathophysiological cascade that includes the lethal triad of hypothermia, metabolic acidosis, and coagulopathy, demanding a coordinated and sequential therapeutic response. Conventional approaches based on Early Total Care have been progressively replaced by sequential strategies such as Damage Control Surgery and Damage Control Orthopaedic Surgery. We present the case of a 34-year-old male, victim of a high-energy motor vehicle accident, who presented with comminuted panfacial fracture, C6-C7 cervical spine injury, bilateral pneumothorax, grade IV hepatic laceration, and type C pelvic fracture (ISS: 41). The patient presented with the lethal triad upon admission. A sequential surgical protocol was implemented in five phases: (1) initial assessment and resuscitation following the xABCDE algorithm; (2) damage control surgery (laparotomy with hepatic packing, thoracotomy, pelvic external fixation, and tracheostomy); (3) intensive care unit stabilization with physiological biomarker monitoring; (4) definitive scheduled surgeries (mandibular and maxillary osteosynthesis, percutaneous pelvic fixation, abdominal wall reconstruction); and (5) secondary reconstruction and rehabilitation. The patient was discharged on day 45, with favorable functional recovery at 6 months. High-energy trauma with simultaneous craniofacial, cervical, thoracic, and abdominal injuries demands an evidence-based sequential surgery protocol integrating the principles of damage control, physiological monitoring, and a multidisciplinary approach. The proposed five-phase protocol allowed for optimizing outcomes in this patient with multisystem injuries of extreme severity. Prospective studies are required to validate its applicability in different clinical settings.
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Copyright (c) 2026 Mario Daniel Hidalgo Flores , Nicolás Montes Salazar , Jenny Mireya Pacheco Cahueñas , Daniel Eduardo Rodriguez Guevara , Sebastián Octavio Cárdenas Cruz
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