Hewitt presented a case of a 19-year-old female with polytrauma following a motor vehicle accident. Initial cervical spine radiographs in the ED were inadequate and subsequently, collar removal was delayed until repeat radiographs were able to be obtained 36 hours later. At that time, the patient developed skin necrosis at the jaw angles and indentations over the occiput and chest. The author concludes that adequate initial radiographs are essential and so is prompt clearance when possible, but if not alternative methods should be considered or the skin should be checked frequently.

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