Strategy of surgical management of polytrauma

Operative procedures in multiple injured patients consist in the first stage in life-saving operations such as control of bleeding and cerebral decompression. Operative measures during the urgent second operative phase have to be undertaken under consideration of the development of a multiple organ failure syndrome. Early stabilization of relevant extremity fractures and thorough care of soft-tissue are of particular importance (day-1-surgery). Only second look procedures to optimize soft-tissue injuries and prevent infections may be allowed during this early intensive care period. Delayed operative procedures should only be performed after stabilization of the overall patient situation to prevent enhancement of the systemic inflammatory response. The required operative procedures of the multiple injuries have to be attributed to the respective operative phases.