Contemporary Strategies in the Management of Civilian Neck Zone II Vascular Trauma

Abstract

Neck trauma is the leading cause of death mainly in younger persons posing to surgeons the dilemma whether to proceed with reconstruction of vascular injuries either in the presence of coma or in severe neurological deficit. Vascular injuries in zone II predominate over the other injuries located in zones I/III of the neck. Conventional open repair of carotid injuries with primary closure or interposition grafting is always recommended due to the effective long-term results for penetrating injuries or for patients unfit for endovascular intervention. In cases of blunt trauma, anticoagulation or antiplatelet therapy should be administered first in neurologically stable patients. In case of worsening of the neurological status of the patient despite adequate anticoagulation endovascular means should be considered in cases of appropriate anatomy of the arterial trauma. We provide an update on penetrating/blunt trauma in zone II of the neck, giving emphasis on the anticoagulant and endovascular treatment.

Neck trauma: a profile of experience from otorhinolaryngology unit of a referral hospital in North West Nigeria

“…6,7,11,12 The management of patients with neck trauma has been debated for many years, and no consensus on when to surgically intervene. [13][14][15][16] The various trends in management have evolved from our experience during war. 1,8,[12][13][14][15][16] The practice during the First World War was that of conservative management for most patients and surgery for a few.…”

“…[13][14][15][16] The various trends in management have evolved from our experience during war. 1,8,[12][13][14][15][16] The practice during the First World War was that of conservative management for most patients and surgery for a few. However, high mortality among patients was reported with this practice.…”

“…Multidetector helical computed tomography with angiography (MDCT-A) has revolutionized the management of patients with neck trauma. 6,7,[13][14][15] Initially used to evaluate vascular trauma, MDCT-A has proven itself useful for evaluating aerodigestive and other forms of trauma in these patients. Access to such cutting edge radio-diagnostic facilities in resource constraint settings drives surgeons in those areas to adopt less conservative methods of treatment, and rather opts to explore the necks of patients, even when they appear to be hemodynamically stable with no hard signs.…”

“…Common carotid and internal carotid injuries are however best repaired in patients without neurological deficits. [12][13][14][15] Laryngeal and tracheal injuries are more common than pharyngeal and esophageal injuries. Airway injuries may range from minor mucosal tears to distortions in the skeletal framework and airway obstruction.…”

“…Minimal hematomas and mucosal tears of the larynx may require observation with humidified air and steroids, while progressively severe injuries with massive edema, exposed cartilage, vocal cord immobility may require extensive repair and stenting. 5,15 Esophageal injuries though rare need a high index of suspicion in asymptomatic patients to prevent life threatening mediastinitis. 6,12,19 In sub-Saharan African countries, the prevalence of Neck injuries is difficult to estimate due largely to paucity of trauma registries.…”