Penetrating trauma to the neck: Using your vascular toolkit

Abstract

P enetrating injuries to the neck can result in devastating injury patterns secondary to the presence of vascular, aerodigestive, and nervous structures in close proximity. 1 Vascular structures are most commonly injured and can have significant morbidity and a high mortality rate depending on the mechanism. Vascular injuries are suspected base on mechanism of injury, physical examination, violation of the platysma, and in some cases computed tomography (CT) imaging. The historical management of these injuries is based on the original description of zones of the neck by Monson at Cook County Hospital in 1969 and resulted in operative exploration of all zone II injuries. 2 However, contemporary management has shifted to a "no-zone" approach, basing decisions on operative exploration or imaging on the presence of hard or soft signs of vascular trauma on physical examination. 3 Soft signs of vascular trauma include nonexpanding hematoma, neurodeficits, and history of blood loss on the scene. The hemodynamically stable patient with soft signs can be taken for CT angiography to evaluate for injuries. Patients with no signs of injury on CT and a nonconcerning trajectory can be discharged from the emergency room. 4 Hard signs of vascular trauma include pulsatile bleeding, expanding hematoma, and thrill on auscultation. Patients with hard signs should be taken directly to the operating room for exploration. 5 Given the severity of these injuries, trauma surgeons must be familiar with neck anatomy, emergent management of vascular injuries, and the possibility of a concomitant tracheoesophageal injury. The operative management of any penetrating neck injury requires the surgeon to progress through multiple critical steps:(1) establishing an airway, (2) neck exploration, and (3) choice of repair or damage-control procedure. Once an injury is identified, management follows universal vascular trauma principles: exposure, proximal and distal control, and, lastly, repair. This video techniques article will focus on the major vascular structures in the neck and relevant anatomy, describe

Prognostic Significance of Multifactorial Analysis in Complex Cervical Aero-Digestive Trauma Cases

“…The unstable patient is provided with respiratory tract concomitant treatment with cervical surgery; the postoperative care of hemodynamic and neurological stability allows for supplementary endoscopic and imaging investigations. The symptomatic stable patient is subjected to endoscopic imaging and angiographic interventional investigations to establish the lesion distribution and the following development of healing conduct [2].…”