Management of penetrating neck injuries at a London trauma centre

Abstract

Penetrating neck injuries (PNIs) are uncommon in the UK. The majority of guidelines are from the USA or South Africa. No UK national guidelines exist. Increasing urban violence in the UK has lead to an increase in PNIs. There is a need to develop a PNI guideline that reflects the pathology and experience in the UK. A retrospective review of all PNIs managed at St George's Hospital over an 18 month period was undertaken. Data collected included patient demographics, mechanism of injury, investigations, multidisciplinary team involvement and management. Clinical activity data was correlated to current worldwide literature and a flow-chart style clinical guideline was produced. 25 neck wounds were managed over an 18 month period. 68 % were male, 32 % female with a mean age of 36 years. The mechanism of injury included deliberate self-harm (48 %), stab wounds (32 %), gunshot wounds (4 %), shotgun wounds (4 %) and other accidental causes (12 %). 52 % of wounds were superficial to platysma. 58 % of deep wounds had CT. 42 % of patients with deep wounds also had panendoscopy. Interventional radiology was used in one case (8 %) and a single case was managed jointly with the vascular team (8 %). UK ENT surgeons have limited exposure to neck trauma and dedicated head and neck out-of-hours cover is uncommon. There is a need for UK PNI guidelines that reflect local pathology and experience. The St George's PNI guideline can be used to facilitate assessment, documentation and management of a relatively infrequent emergency presentation.

Non-iatrogenic civilian vascular trauma in a well-defined geographical region in Finland

“…It has been proposed that endovascular procedure could be used as a first-line procedure in some penetrating vascular injuries [17]. In our material it was used, however, only in 15 cases, and mainly for isolated penetrating vascular injuries.…”

“…Although interventional radiology has evolved rapidly, only the minority of vascular traumas are treated by endovascular means [13][14][15][16][17][18]. It has been proposed that endovascular procedure could be used as a first-line procedure in some penetrating vascular injuries [17].…”

“…In theory, shorter operative time and faster hemostasis could be achieved by using endovascular techniques [19]. Nevertheless, endovascular procedure as the first-line treatment in civilian vascular trauma is utilized in approximately 8 % of the reported cases [17,19].…”

Hallazgos Clínicos y Quirúrgicos en Pacientes con Trauma Penetrante de Cuello en el Hospital Universitario de Santander

“…El presente estudio describe las principales características clínicas y el tratamiento de una muestra de pacientes que tuvieron trauma penetrante en cuello en un Hospital Universitario, recientemente los estudios referentes al tema se han caracterizado por ser reportes de caso clínico y otros en menor cantidad han contado con una mayor cantidad de pacientes siendo estudios de naturaleza descriptiva, analítica y en algunos casos prospectiva en Norteamérica, Reino Unido, África, Asia, [11][12][13][14] sin embargo en Latinoamérica los estudios han sido escasos al respecto a excepción de Brasil. [15][16][17] En cuanto a variables sociodemográficas tanto en nuestros datos como en los referentes, el sexo masculino prevalece y la edad de mayor presentación está alrededor por debajo de los 30 años de edad.…”

“…15 Por otra parte, de acuerdo a las características clínicas de los pacientes observados tuvieron un comportamiento similar a lo reportado previamente, por ejemplo la zona 2 continua siendo la zona donde más se producen los traumas, además la violencia reflejado en las heridas por arma de fuego y cortopunzante son los mecanismos más implicados). 11,12,18 En cuanto a las lesiones asociadas al trauma penetrante de cuello por zona anatómica hay una diferencia con el estudio de Madsen y colaboradores en Sudáfrica dado que el principal sitio afectado no son los miembros superiores, sino el tórax, zona que ocupa el segundo lugar en nuestro estudio. 18 En el presente estudio encontramos un enfoque diagnóstico basado en un algoritmo más compatible con "No Zone Approach," dado que hay un gran apoyo en la Angiotomografía de cuello para los pacientes con algún signo o síntoma blando e Inclusive en pacientes asintomáticos.…”