• C Denz, T Luiz, G Merkel, and M Quintel.
• Institut für Anästhesiologie und Operative Intensivmedizin, Fakultät für Klinische Medizin Mannheim, Universität Heidelberg.
• Anasthesiol Intensivmed Notfallmed Schmerzther. 1999 Feb 1; 34 (2): 105109105-9.

AbstractTreatment of severe haemorrhage caused by multiple trauma is a serious challenge to preclinical as well as clinical management. This is a case report of a motorcycle accident in which a patient sustained total amputation of both legs. Following adequate preclinical care, vital indication led to the patient's immediate surgical treatment. After initially successful haemodynamic stabilisation, the patient developed a horizontal deceleration trauma which resulted in an extended decollement of the muscles of the back and buttock. During the further clinical course, soft tissue bleeding occurred that affected the whole torso. Due to its extent, the bleeding could not be treated surgically, nor did it allow of haemodynamic stabilisation despite continuous massive transfusion. Retrospectively, the impressing amputation injury was treated successfully. In spite of all available surgical and intensive care efforts, however, the slowly demasking monstrous decollement with diffuse tissue bleeding proved to be an injury pattern leading to the patient's death.

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