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Muñoz CA, Hadad AG, González P, Burgos A, Ordoñez CA, Serna JJ. Carotid artery penetrating trauma: Report of 4 cases and literature revision. Int J Surg Case Rep 2024; 121:109940. [PMID: 38971033 PMCID: PMC11269920 DOI: 10.1016/j.ijscr.2024.109940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 06/17/2024] [Accepted: 06/21/2024] [Indexed: 07/08/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE In penetrating neck trauma, carotid artery penetrating trauma is considered one of the most complicated injuries to treat. Active bleeding, large hematomas, and rapid occlusion of the airways make the surgical approach to controlling bleeding and repairing the vessel much more complex, constituting an essential clinical challenge to every surgeon. CASE PRESENTATION We present 4 cases of patients with carotid artery penetrating trauma. Two patients were treated with endovascular therapy, one with surgery, and the fourth one treated conservatively. None of the patients had posterior neurological impairment. CLINICAL DISCUSSION Carotid artery penetrating trauma is uncommon yet is associated with high rates of mortality and neurological impairment. The common carotid artery is the most frequently injured, and gunshot wounds (GSW) are the most frequent trauma mechanism. Angiotomography (CTA) is the first-line exam for diagnosing these injuries. Treatment should be prompt and individualized and may include conservative techniques, endovascular therapy, and traditional surgical repair. CONCLUSION Carotid artery penetrating trauma is an uncommon but complex injury that requires a timely diagnosis and treatment to avoid potentially devastating consequences, particularly in hemodynamically unstable patients. Traditionally, the treatment strategies for these injuries used to be limited to vascular repair or ligation. However, endovascular therapy and conservative management are viable alternatives, which have become more and more useful in selected patients, allowing less invasive approaches with fewer morbidity and acceptable results.
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Affiliation(s)
- Carlos Andres Muñoz
- Departamento de Cirugía de Trauma y Emergencias, Universidad del Valle, Hospital Universitario del Valle, Cali, Colombia.
| | - Adolfo González Hadad
- Departamento de Cirugía de Trauma y Emergencias, Universidad del Valle, Hospital Universitario del Valle, Cali, Colombia.
| | - Paola González
- Departamento de Cirugía General, Universidad del Valle, Hospital Universitario del Valle, Cali, Colombia
| | - Alejandro Burgos
- Departamento de Cirugía General, Universidad del Valle, Hospital Universitario del Valle, Cali, Colombia
| | - Carlos Alberto Ordoñez
- Departamento de Cirugía de Trauma y Emergencias, Universidad del Valle, Hospital Universitario del Valle, Cali, Colombia; Departamento de Cirugía de Trauma y Emergencias, Fundación Valle del Lili, Cali, Colombia
| | - José Julián Serna
- Departamento de Cirugía de Trauma y Emergencias, Universidad del Valle, Hospital Universitario del Valle, Cali, Colombia; Departamento de Cirugía de Trauma y Emergencias, Fundación Valle del Lili, Cali, Colombia
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Severin F, Danila R, Nicolau A, Alexa AI, Olariu R, Roșca Ș, Palade OD, Mocanu F, Cobzeanu MD, Cobzeanu BM. Prognostic Significance of Multifactorial Analysis in Complex Cervical Aero-Digestive Trauma Cases. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:238. [PMID: 38399525 PMCID: PMC10890607 DOI: 10.3390/medicina60020238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: In the context of complex aerodigestive cervical traumas, the prognosis and outcome heavily depend on risk factors, particularly injuries to the larynx, trachea, major digestive tissues, cervical vertebrae, and vascular structures. With the increasing prevalence of trauma as a public health concern, there is a pressing need for epidemiological research and the implementation of preventative measures. The purpose of this research is to establish the profile of the predictable impact factors that determine the prognosis of patients with complex cervical trauma. Methods and Methods: The study group consisted of 106 patients with complex cervical trauma pathology developed by various mechanisms such as car accidents, home-related accidents, aggression, gunshot wounds, and self-inflicted attempts, resulting in hospitalization in the E.N.T. Clinic at "St. Spiridon" Iași Hospital, from 2012 to 2016; medical records were the source of the collected data. Results: Hemodynamic instability upon admission associated with age, muscle and laryngeal injuries, and anemia were identified as negative prognostic factors. Additionally, the utilization of imaging-based paraclinical investigations for diagnosing traumatic lesions emerged as a positive prognostic factor in managing this pathology. The management of penetrating cervical trauma remains a subject of debate, with some advocating for surgical exploration beyond the platysma layer in all cases, while others argue for a more selective conservative approach due to a high rate of negative explorations. Conclusions: The statistical evaluation of epidemiological, clinical, lesion, paraclinical, and therapeutic parameters is needed to establish predictable risk factors in the prognosis of complex aerodigestive cervical trauma.
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Affiliation(s)
- Florentina Severin
- Surgery Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (F.S.); (R.D.); (A.N.); (A.I.A.); (R.O.); (M.D.C.); bogdan- (B.M.C.)
| | - Radu Danila
- Surgery Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (F.S.); (R.D.); (A.N.); (A.I.A.); (R.O.); (M.D.C.); bogdan- (B.M.C.)
| | - Andrei Nicolau
- Surgery Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (F.S.); (R.D.); (A.N.); (A.I.A.); (R.O.); (M.D.C.); bogdan- (B.M.C.)
| | - Anisia Iuliana Alexa
- Surgery Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (F.S.); (R.D.); (A.N.); (A.I.A.); (R.O.); (M.D.C.); bogdan- (B.M.C.)
| | - Raluca Olariu
- Surgery Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (F.S.); (R.D.); (A.N.); (A.I.A.); (R.O.); (M.D.C.); bogdan- (B.M.C.)
| | - Ștefan Roșca
- Clinical Departement, “Dunarea de Jos” University, 800008 Galati, Romania;
| | - Octavian Dragos Palade
- Surgery Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (F.S.); (R.D.); (A.N.); (A.I.A.); (R.O.); (M.D.C.); bogdan- (B.M.C.)
| | - Florin Mocanu
- Surgery Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (F.S.); (R.D.); (A.N.); (A.I.A.); (R.O.); (M.D.C.); bogdan- (B.M.C.)
| | - Mihail Dan Cobzeanu
- Surgery Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (F.S.); (R.D.); (A.N.); (A.I.A.); (R.O.); (M.D.C.); bogdan- (B.M.C.)
| | - Bogdan Mihail Cobzeanu
- Surgery Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (F.S.); (R.D.); (A.N.); (A.I.A.); (R.O.); (M.D.C.); bogdan- (B.M.C.)
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Góes AMDO, Parreira JG, Kleinsorge GHD, Dalio MB, Alves PHF, Gomes FJSDDV, de Araujo WJB, Joviliano EE, de Oliveira JCP. Brazilian guidelines on diagnosis and management of traumatic vascular injuries. J Vasc Bras 2023; 22:e20230042. [PMID: 38021277 PMCID: PMC10647898 DOI: 10.1590/1677-5449.202300422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/15/2023] [Indexed: 12/01/2023] Open
Abstract
Trauma is a leading cause of death, permanent disability, and health care cost worldwide. The young and economically active are the most affected population. Exsanguination due to noncompressible torso hemorrhage is one of the most frequent causes of early death, posing a significant challenge to trauma and vascular surgeons. The possibility of limb loss due to vascular injuries must also be considered. In recent decades, the approach to vascular injuries has been significantly modified. Angiotomography has become the standard method for diagnosis, endovascular techniques are currently incorporated in treatment, and damage control, such as temporary shunts, is now the preferred approach for the patients sustaining physiological derangement. Despite the importance of this topic, few papers in the Brazilian literature have offered guidelines on vascular trauma. The Brazilian Society of Angiology and Vascular Surgery has developed Projetos Diretrizes (Guideline Projects), which includes this publication on vascular trauma. Since treating trauma patients is a multidisciplinary effort, the Brazilian Trauma Society (SBAIT) was invited to participate in this project. Members of both societies reviewed the literature on vascular trauma management and together wrote these guidelines on vascular injuries of neck, thorax, abdomen, and extremities.
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Affiliation(s)
- Adenauer Marinho de Oliveira Góes
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular - SBAC, São Paulo, SP, Brasil.
- Sociedade Brasileira de Atendimento Integrado ao Traumatizado - SBAIT, São Paulo, SP, Brasil.
- Centro Universitário do Pará - CESUPA, Faculdade de Medicina, Belém, PA, Brasil.
- Universidade Federal do Pará - UFPA, Faculdade de Medicina, Belém, PA, Brasil.
| | - José Gustavo Parreira
- Sociedade Brasileira de Atendimento Integrado ao Traumatizado - SBAIT, São Paulo, SP, Brasil.
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Cirurgia, São Paulo, SP, Brasil.
| | - Gustavo Henrique Dumont Kleinsorge
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular - SBAC, São Paulo, SP, Brasil.
- Sociedade Brasileira de Atendimento Integrado ao Traumatizado - SBAIT, São Paulo, SP, Brasil.
- Fundação Hospitalar do Estado de Minas Gerais - FHEMIG, Clínica de Cirurgia Vascular, Hospital João XXIII, Belo Horizonte, MG, Brasil.
| | - Marcelo Bellini Dalio
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular - SBAC, São Paulo, SP, Brasil.
- Universidade de São Paulo - USP, Divisão de Cirurgia Vascular e Endovascular, Hospital das Clínicas, Ribeirão Preto, SP, Brasil.
| | - Pedro Henrique Ferreira Alves
- Sociedade Brasileira de Atendimento Integrado ao Traumatizado - SBAIT, São Paulo, SP, Brasil.
- Universidade de São Paulo - USP, Faculdade de Medicina, Hospital das Clínicas, III Clínica Cirúrgica, São Paulo, SP, Brasil.
| | - Francisco João Sahagoff de Deus Vieira Gomes
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular - SBAC, São Paulo, SP, Brasil.
- Sociedade Brasileira de Atendimento Integrado ao Traumatizado - SBAIT, São Paulo, SP, Brasil.
- Universidade do Estado do Rio de Janeiro - UERJ, Faculdade de Ciências Médicas, Departamento de Cirurgia, Rio de Janeiro, RJ, Brasil.
- Polícia Militar do Estado do Rio de Janeiro - PMERJ, Rio de Janeiro, RJ, Brasil.
| | - Walter Junior Boim de Araujo
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular - SBAC, São Paulo, SP, Brasil.
- Universidade Federal do Paraná - UFPR, Hospital das Clínicas, Divisão de Angiorradiologia e Cirurgia Endovascular, Curitiba, PR, Brasil.
| | - Edwaldo Edner Joviliano
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular - SBAC, São Paulo, SP, Brasil.
- Universidade de São Paulo - USP, Divisão de Cirurgia Vascular e Endovascular, Hospital das Clínicas, Ribeirão Preto, SP, Brasil.
| | - Julio Cesar Peclat de Oliveira
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular - SBAC, São Paulo, SP, Brasil.
- Universidade Federal do Estado do Rio de Janeiro - UNIRIO, Departamento de Cirurgia, Rio de Janeiro, RJ, Brasil.
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Plotkin A, Weaver FA, Owattanapanich N, Byerly S, Schellenberg M, Inaba K, Magee GA. Epidemiology, repair technique, and predictors of stroke and mortality in penetrating carotid artery injuries. J Vasc Surg 2023; 78:920-928. [PMID: 37379894 DOI: 10.1016/j.jvs.2023.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/15/2023] [Accepted: 06/17/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVE Penetrating carotid artery injuries (PCAI) are significantly morbid and deadly, often presenting in extremis with associated injuries and central nervous system deficit. Repair may be challenging with arterial reconstruction vs ligation role poorly defined. This study evaluated contemporary outcomes and management of PCAI. METHODS PCAI patients in the National Trauma Data Bank from 2007 to 2018 were analyzed. Outcomes were compared between repair and ligation groups after additionally excluding external carotid injuries, concomitant jugular vein injuries, and head/spine Abbreviated Injury Severity score of ≥3. Primary end points were in-hospital mortality and stroke. Secondary end points were associated injury frequency and operative management. RESULTS There were 4723 PCAI (55.7% gunshot wounds, 44.1% stab wounds). Gunshot wounds more frequently had associated brain (73.8% vs 19.7%; P < .001) and spinal cord (7.6% vs 1.2%; P < .001) injuries; stab wounds more frequently had jugular vein injuries (19.7% vs 29.3%; P < .001). The overall in-hospital mortality was 21.9% and the stroke rate was 6.2%. After exclusion criteria, 239 patients underwent ligation and 483 surgical repair. Ligation patients had lower presenting Glasgow Coma Scale (GCS) than repair patients (13 vs 15; P = .010). Stroke rates were equivalent (10.9% vs 9.3%; P = .507); however, in-hospital mortality was higher after ligation (19.7% vs 8.7%; P < .001). In-hospital mortality was higher in ligated common carotid artery injuries (21.3% vs 11.6%; P = .028) and internal carotid artery injuries (24.5% vs 7.3%; P = .005) compared with repair. On multivariable analysis, ligation was associated with in-hospital mortality, but not with stroke. A history of neurological deficit before injury lower GCS, and higher Injury Severity Score (ISS) were associated with stroke; ligation, hypotension, higher ISS, lower GCS, and cardiac arrest were associated with in-hospital mortality. CONCLUSIONS PCAI are associated with a 22% rate of in-hospital mortality and a 6% rate of stroke. In this study, carotid repair was not associated with a decreased stroke rate, but did have improved mortality outcomes compared with ligation. The only factors associated with postoperative stroke were low GCS, high ISS, and a history of neurological deficit before injury. Beside ligation, low GCS, high ISS, and postoperative cardiac arrest were associated with in-hospital mortality.
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Affiliation(s)
- Anastasia Plotkin
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Fred A Weaver
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Natthida Owattanapanich
- Division of Trauma and Acute Care Surgery, Department of Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA
| | - Saskya Byerly
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN
| | - Morgan Schellenberg
- Division of Trauma and Acute Care Surgery, Department of Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA
| | - Kenji Inaba
- Division of Trauma and Acute Care Surgery, Department of Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA
| | - Gregory A Magee
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.
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Hassan S, Tchijov S. Penetrating carotid artery injury by air rifle: a case report. J Med Case Rep 2023; 17:358. [PMID: 37574539 PMCID: PMC10424389 DOI: 10.1186/s13256-023-04080-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 07/14/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Air rifle injuries can cause significant vascular injuries. This air rifle injury has resulted in a penetrating neck trauma traversing the common carotid artery. There is debate around the need for radiological investigation, the most appropriate investigational modality, and the need for surgical exploration versus a conservative approach. This case report aims to exemplify a successful approach to managing Penetrating Carotid Injuries (PCI) while shedding light on the rationale behind the management decisions. PRESENTATION An 18-year-old Caucasian man arrived at the hospital following an air rifle injury to the right side of the neck, with active bleeding and a moderate haematoma displacing the trachea. He was haemodynamically stable, with a Glasgow Coma Scale (GCS) of 15 and no evidence of bruit. Computed Tomography Angiography (CTA) showed Right common carotid (CCA) artery injury with associated post-traumatic pseudoaneurysm. The pellet trajectory traverses the right superior thyroid gland. A duplex ultrasound scan (USS) confirmed two areas of arterial blush at the right CCA. Management involved neck exploration under General Anaesthesia (G.A.), repair of right CCA, bullet extraction, and wound washout. He received antibiotics for ten days and a single agent of antiplatelets for three months and was discharged two days postoperatively with no complications. He was followed up for eight months with no evidence of any trauma sequelae. CONCLUSION Penetrating carotid artery injuries are a serious concern. The small-sized pellets carry the risk of embolization. Therefore, neck exploration remains the gold standard treatment for PCI. Appropriate operative planning is crucial and can be optimised using radiological diagnostic modalities in haemodynamically stable patients. CTA is a non-invasive, swift, and adequate alternative to arteriography, providing valuable diagnostic information on vascular and aerodigestive injuries and bullet trajectory. This enables appropriate preparedness to achieve excellent outcomes in such critical cases.
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Affiliation(s)
- Summer Hassan
- Department of Vascular Surgery, Middlemore Hospital, Auckland University, 100 Hospital Road, Auckland, New Zealand.
- University of Auckland, Auckland, New Zealand.
| | - Sergei Tchijov
- Department of Vascular Surgery, Middlemore Hospital, Auckland University, 100 Hospital Road, Auckland, New Zealand
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Yang X, Liu Z, Sun Q, Mou Y, Jia C, Zhang W, Song F, Li W, Zhang H, Song X. Case Report: Two cases of survival after complete transection of the left common carotid artery. Front Surg 2023; 9:1082658. [PMID: 36817067 PMCID: PMC9935701 DOI: 10.3389/fsurg.2022.1082658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/16/2022] [Indexed: 02/05/2023] Open
Abstract
Penetrating carotid artery traumas are rare yet fatal injuries with a high rate of mortality, and survivors may live with neurological sequelae. Of all the types of penetrating carotid artery traumas, the total transection of the common carotid artery (CCA) may be the most serious, can lead to death quickly, and has few reports of survivors. We described two cases of patients with complete CCA transections who survived without any neurological sequelae. The penetrating neck traumas of both patients were confirmed as complete CCA severance by CT and surgical exploration. Case 1 received the insertion of an interposition polytetrafluoroethylene graft to reconstruct the CCA, with postoperative ultrasound and CT angiography (CTA) verifying the total occlusion. Case 2 underwent nonoperative management under close observation and did not develop delayed active bleeding or neurological symptoms. Both patients recovered well, and no nervous system sequelae appeared during the follow-up period. A carotid artery injury cannot be ruled out in an asymptomatic penetrating neck injury. If CTA is feasible given the patient's hemodynamic condition, then it should be used as a routine examination to evaluate cervical vascular injury in patients with penetrating neck trauma. Management for hemodynamically stable carotid artery injuries remains controversial. These two cases of transverse carotid artery injury have caused us to further consider the principles of this kind of case management.
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Affiliation(s)
- Xin Yang
- Department of Otorhinolaryngology Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China,Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China
| | - Zhonglu Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China,Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China
| | - Qi Sun
- Department of Otorhinolaryngology Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China,Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China
| | - Yakui Mou
- Department of Otorhinolaryngology Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China,Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China
| | - Chuanliang Jia
- Department of Otorhinolaryngology Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China,Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China
| | - Wenbin Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China,Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China
| | - Fei Song
- Department of Otorhinolaryngology Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China,Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China
| | - Wen Li
- Department of General Surgery, Yantai Municipal Laiyang Central Hospital, Laiyang, China
| | - Hua Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China,Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China,Correspondence: Xicheng Song ; Hua Zhang
| | - Xicheng Song
- Department of Otorhinolaryngology Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China,Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China,Correspondence: Xicheng Song ; Hua Zhang
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Transcervical intubation for massive self-inflicted neck wound transecting the epiglottis. Trauma Case Rep 2022; 43:100752. [PMID: 36647438 PMCID: PMC9840176 DOI: 10.1016/j.tcr.2022.100752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2022] [Indexed: 01/01/2023] Open
Abstract
Background Penetrating trauma to the larynx is a rare phenomenon with a high risk of mortality and morbidity due to the density of vital structures in the area (Demetriades et al., 1996). Most commonly, this type of injury is due to a gunshot wound or knife injury (Snow and Ballenger, 2003). In cases of suicidal cutthroat injury, it is relatively rare to penetrate the airway (Symbas et al., 1976). Case report We present a case of self-penetrating trauma to the anterior neck allowing access for direct laryngeal visualization and transcervical intubation in the field. We describe the immediate workup, surgical intervention, and postoperative management. We focus on managing postoperative cough, secretion management, decannulation, and resultant dysphagia. Conclusion Penetrating laryngeal trauma resulting in airway transection is a rare but potentially fatal phenomenon in which airway management and aggressive post-operative care for severe coughing and dysphagia should be performed to help improve patient outcomes.
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Spontaneous Recovery of Penetrating Cervical Spinal Cord Injury with Physiotherapeutic Treatment: Case Report and Review of the Literature. Case Rep Neurol Med 2022; 2021:3741461. [PMID: 34987873 PMCID: PMC8720595 DOI: 10.1155/2021/3741461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 12/01/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022] Open
Abstract
Stab wounds to the cervical spine are less common than injuries from road accidents, sports injuries, and falls. The presence of vital, vascular, neural, respiratory, and digestive structures in the neck region mean that this kind of spinal injury is generally critical, and its management is a challenge. We report a unique case of a previously healthy 17-year-old adolescent admitted for quadriplegia secondary to a stab wound to the cervical spine at the C4C5 level. There was no surgical indication. The patient underwent physiotherapy. He showed spontaneous neurological improvement two weeks later and was able to sit on his own and to walk about three months of physical rehabilitation.
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Serna JJ, Ordoñez CA, Parra MW, Serna C, Caicedo Y, Rosero A, Velásquez F, Serna C, Salcedo A, González-Hadad A, García A, Herrera MA, Pino LF, Franco MJ, Rodríguez-Holguín F. Damage control in penetrating carotid artery trauma: changing a 100-year paradigm. Colomb Med (Cali) 2021; 52:e4054807. [PMID: 34908620 PMCID: PMC8634279 DOI: 10.25100/cm.v52i2.4807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/30/2021] [Accepted: 06/09/2021] [Indexed: 11/11/2022] Open
Abstract
Carotid artery trauma carries a high risk of neurological sequelae and death. Surgical management of these injuries has been controversial because it entails deciding between repair or ligation of the vessel, for which there is still no true consensus either way. This article proposes a new management strategy for carotid artery injuries based on the principles of damage control surgery which include endovascular and/or traditional open repair techniques. The decision to operate immediately or to perform further imaging studies will depend on the patient's hemodynamic status. If the patient presents with massive bleeding, an expanding neck hematoma or refractory hypovolemic shock, urgent surgical intervention is indicated. An altered mental status upon arrival is a potentially poor prognosis marker and should be taken into account in the therapeutic decision-making. We describe a step-by-step algorithmic approach to these injuries, including open and endovascular techniques. In addition, conservative non-operative management has also been included as a potentially viable strategy in selected patients, which avoids unnecessary surgery in many cases.
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Affiliation(s)
- José Julián Serna
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia.,Universidad Icesi, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Carlos A Ordoñez
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia.,Universidad Icesi, Cali, Colombia
| | - Michael W Parra
- Broward General Level I Trauma Center, Department of Trauma Critical Care, Fort Lauderdale FL , USA
| | - Carlos Serna
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
| | - Yaset Caicedo
- Fundación Valle del Lili, Centro de Investigaciones Clínicas (CIC), Cali, Colombia
| | - Alberto Rosero
- Fundación Valle del Lili, Department of Radiology, Division of Neuroradiology, Cali, Colombia
| | | | - Carlos Serna
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
| | - Alexander Salcedo
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia.,Universidad Icesi, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Adolfo González-Hadad
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Centro Médico Imbanaco, Cali, Colombia
| | - Alberto García
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia.,Universidad Icesi, Cali, Colombia
| | - Mario Alain Herrera
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Luis Fernando Pino
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Maria Josefa Franco
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Fernando Rodríguez-Holguín
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
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Serna-Arbeláez CA, Saldarriaga L, Folleco E, Rosero AL, Caicedo Y, Timaran SD, Serna JJ, García A, Rodríguez-Holguín F, Ordoñez Delgado CA. La nueva realidad: Manejo endovascular del trauma de carótida. REVISTA COLOMBIANA DE CIRUGÍA 2021. [DOI: 10.30944/20117582.832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. La mayoría de las lesiones de carótida cervical en nuestra institución se manejan por vía endovascular. El objetivo de este estudio fue describir los desenlaces del manejo de las lesiones de carótida cervical en un hospital de cuarto nivel en la ciudad de Cali, Colombia.
Métodos. Estudio de series de casos, retrospectivo, descriptivo, en pacientes con trauma de carótida (penetrante y cerrado), admitidos en un centro de alta complejidad de la ciudad de Cali, en el periodo comprendido desde enero de 2018 hasta enero de 2020.
Resultados. Se evaluaron 20 pacientes con lesión de carótida, de los cuales 90 % tenía trauma penetrante, en su mayoría por proyectil de arma de fuego. La zona más frecuentemente afectada fue la carótida interna (65 %) y el 40 % de los pacientes presentaban síntomas neurológicos al ingreso. Se realizó manejo endovascular en 13 pacientes, con un 75 % de éxito en el manejo endovascular al ingreso. La mortalidad general fue del 20 %, que en su mayoría estuvo relacionada con traumatismo en otros órganos. El 69 % de los pacientes quedaron sin secuelas neurológicas al alta y el 25 % con secuelas mínimas.
Discusión. Se muestra una serie de casos con lesión de carótida donde, teniendo en cuenta las variables de mal pronóstico para hacer una selección adecuada de los pacientes candidatos a este tipo de terapia, el resultado del manejo endovascular fue exitoso.
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11
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Jenkins LN, Rezende-Neto JB. Current Management of Penetrating Traumatic Cervical Vascular Injuries. CURRENT SURGERY REPORTS 2020. [DOI: 10.1007/s40137-020-00258-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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12
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Blitzer DN, Ottochian M, O'Connor J, Feliciano DV, Morrison JJ, DuBose JJ, Scalea TM. Penetrating Injury to the Carotid Artery: Characterizing Presentation and Outcomes from the National Trauma Data Bank. Ann Vasc Surg 2020; 67:192-199. [PMID: 32217135 DOI: 10.1016/j.avsg.2020.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 03/02/2020] [Accepted: 03/05/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Penetrating injury to the neck can be devastating because of the multiple vital structures in close proximity. In the event of injury to the carotid artery, there is a significantly increased likelihood of morbidity or mortality. The purpose of this study was to assess presenting characteristics associated with penetrating injury to the carotid artery and directly compare approaches to surgical management. METHODS Data from the National Trauma Data Bank from 2002-2016 were accessed to evaluate adult patients sustaining penetrating injury to the common or internal carotid artery. Management (operative versus nonoperative) and surgical approach (open versus endovascular) were evaluated based on presentation characteristics, and outcomes were compared after propensity score matching. RESULTS Three thousand three hundred ninety-one patients fitting inclusion criteria and surviving past the emergency department were included in analyses (nonoperative: 1,976 [58.3%] patients and operative: 1,415 [41.7%] patients). The operative group was further classified by intervention as open = 1,192 patients and endovascular: 154 patients. On presentation, the nonoperative group demonstrated significantly higher prevalence of coma (Glasgow Coma Scale ≤8: nonoperative = 49.3% versus operative = 40.8%, P < 0.001), severe overall injury burden (Injury Severity Score ≥25: nonoperative = 42.3% versus operative = 33.3%, P < 0.001), and severe head injury (Abbreviated Injury Score ≥ 3: nonoperative = 44.9% versus operative = 22.0%, P < 0.001). After propensity score matching, the nonoperative group demonstrated higher mortality (nonoperative = 28.9% versus operative = 18.5%, P < 0.001), and lower rates of stroke (nonoperative = 6.6% versus operative - = 10.5%, P < 0.001). There were no differences in outcomes relating to surgical approach. CONCLUSIONS These results indicate that nonoperative patients often present with a more severe overall injury burden, particularly injury to the head, and not surprisingly, have higher rates of mortality. The lack of significant differences in outcomes relating to surgical approach indicates open versus endovascular invention should be individualized to the patient-for example, based on presenting characteristics and the location of the injury.
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Affiliation(s)
- David N Blitzer
- Department of Surgery, MedStar Health Baltimore, Baltimore, MD
| | - Marcus Ottochian
- R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD
| | - James O'Connor
- R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD
| | - David V Feliciano
- R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD
| | | | - Joseph J DuBose
- R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD
| | - Thomas M Scalea
- R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD
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13
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Spahn DR, Bouillon B, Cerny V, Duranteau J, Filipescu D, Hunt BJ, Komadina R, Maegele M, Nardi G, Riddez L, Samama CM, Vincent JL, Rossaint R. The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition. Crit Care 2019; 23:98. [PMID: 30917843 PMCID: PMC6436241 DOI: 10.1186/s13054-019-2347-3] [Citation(s) in RCA: 704] [Impact Index Per Article: 140.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 02/06/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Severe traumatic injury continues to present challenges to healthcare systems around the world, and post-traumatic bleeding remains a leading cause of potentially preventable death among injured patients. Now in its fifth edition, this document aims to provide guidance on the management of major bleeding and coagulopathy following traumatic injury and encourages adaptation of the guiding principles described here to individual institutional circumstances and resources. METHODS The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma was founded in 2004, and the current author group included representatives of six relevant European professional societies. The group applied a structured, evidence-based consensus approach to address scientific queries that served as the basis for each recommendation and supporting rationale. Expert opinion and current clinical practice were also considered, particularly in areas in which randomised clinical trials have not or cannot be performed. Existing recommendations were re-examined and revised based on scientific evidence that has emerged since the previous edition and observed shifts in clinical practice. New recommendations were formulated to reflect current clinical concerns and areas in which new research data have been generated. RESULTS Advances in our understanding of the pathophysiology of post-traumatic coagulopathy have supported improved management strategies, including evidence that early, individualised goal-directed treatment improves the outcome of severely injured patients. The overall organisation of the current guideline has been designed to reflect the clinical decision-making process along the patient pathway in an approximate temporal sequence. Recommendations are grouped behind the rationale for key decision points, which are patient- or problem-oriented rather than related to specific treatment modalities. While these recommendations provide guidance for the diagnosis and treatment of major bleeding and coagulopathy, emerging evidence supports the author group's belief that the greatest outcome improvement can be achieved through education and the establishment of and adherence to local clinical management algorithms. CONCLUSIONS A multidisciplinary approach and adherence to evidence-based guidance are key to improving patient outcomes. If incorporated into local practice, these clinical practice guidelines have the potential to ensure a uniform standard of care across Europe and beyond and better outcomes for the severely bleeding trauma patient.
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Affiliation(s)
- Donat R. Spahn
- Institute of Anaesthesiology, University of Zurich and University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Bertil Bouillon
- Department of Trauma and Orthopaedic Surgery, Cologne-Merheim Medical Centre (CMMC), University of Witten/Herdecke, Ostmerheimer Strasse 200, D-51109 Cologne, Germany
| | - Vladimir Cerny
- Department of Anaesthesiology, Perioperative Medicine and Intensive Care, J.E. Purkinje University, Masaryk Hospital, Usti nad Labem, Socialni pece 3316/12A, CZ-40113 Usti nad Labem, Czech Republic
- Centre for Research and Development, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic, Sokolska 581, CZ-50005 Hradec Kralove, Czech Republic
- Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine in Hradec Kralove, Charles University, Simkova 870, CZ-50003 Hradec Kralove, Czech Republic
- Department of Anaesthesia, Pain Management and Perioperative Medicine, QE II Health Sciences Centre, Dalhousie University, Halifax, 10 West Victoria, 1276 South Park St, Halifax, NS B3H 2Y9 Canada
| | - Jacques Duranteau
- Department of Anaesthesia and Intensive Care, Hôpitaux Universitaires Paris Sud, University of Paris XI, Faculté de Médecine Paris-Sud, 78 rue du Général Leclerc, F-94275 Le Kremlin-Bicêtre Cedex, France
| | - Daniela Filipescu
- Department of Cardiac Anaesthesia and Intensive Care, C. C. Iliescu Emergency Institute of Cardiovascular Diseases, Sos Fundeni 256-258, RO-022328 Bucharest, Romania
| | - Beverley J. Hunt
- King’s College and Departments of Haematology and Pathology, Guy’s and St Thomas’ NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH UK
| | - Radko Komadina
- Department of Traumatology, General and Teaching Hospital Celje, Medical Faculty Ljubljana University, SI-3000 Celje, Slovenia
| | - Marc Maegele
- Department of Trauma and Orthopaedic Surgery, Cologne-Merheim Medical Centre (CMMC), Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Ostmerheimer Strasse 200, D-51109 Cologne, Germany
| | - Giuseppe Nardi
- Department of Anaesthesia and ICU, AUSL della Romagna, Infermi Hospital Rimini, Viale Settembrini, 2, I-47924 Rimini, Italy
| | - Louis Riddez
- Department of Surgery and Trauma, Karolinska University Hospital, S-171 76 Solna, Sweden
| | - Charles-Marc Samama
- Hotel-Dieu University Hospital, 1, place du Parvis de Notre-Dame, F-75181 Paris Cedex 04, France
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, B-1070 Brussels, Belgium
| | - Rolf Rossaint
- Department of Anaesthesiology, University Hospital Aachen, RWTH Aachen University, Pauwelsstrasse 30, D-52074 Aachen, Germany
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Traumatic Penetrating Neck Injury with Right Common Carotid Artery Dissection and Stenosis Effectively Managed with Stenting: A Case Report and Review of the Literature. Case Rep Vasc Med 2018; 2018:4602743. [PMID: 29984035 PMCID: PMC6015681 DOI: 10.1155/2018/4602743] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 05/21/2018] [Indexed: 02/05/2023] Open
Abstract
Introduction Penetrating neck injuries (PNI) are common and associated with arterial and other neuronal injuries. Although many authors have written on penetrating and blunt carotid artery injuries as a result of PNI or traumatic neck injuries, no one has reported a case or case series on PNI that resulted in blunt carotid dissection and stenosis. Case Presentation We present a case of 40-year-old building and construction male worker who slipped and fell on an iron rod that resulted in penetrating wound on the right side of the anterior neck a week prior to presenting at our facility. He pulled out the iron rod immediately. Computer tomography angiography (CTA) done revealed C2-C4 transverse process fractures on the right side and a fracture at the right lamina of C3 and right common carotid artery dissection with stenosis. He was successfully treated with stenting via endovascular approach. Conclusions We adopt the view that patient should never pull out objects that result in PNI because of complex neurovascular architecture of the neck. The mortality rate of our patient will have doubled if the iron rode penetrated the common carotid artery. The gold standard treatment option for carotid artery dissection and stenosis is endovascular approaches.
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15
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Naqvi Sayyed E, Sadik A, Beg M, Azam H, Nadeem R, Eram A. Successful management of suicidal cut throat injury with internal jugular, tracheal and esophageal transection: A case report. Trauma Case Rep 2018; 13:30-34. [PMID: 29644295 PMCID: PMC5887116 DOI: 10.1016/j.tcr.2017.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2017] [Indexed: 11/17/2022] Open
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16
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Casal D, Pelliccia G, Pais D, Carrola-Gomes D, Angélica-Almeida M, Videira-Castro J, Goyri-O'Neill J. Stab injury to the preauricular region with laceration of the external carotid artery without involvement of the facial nerve: a case report. J Med Case Rep 2017; 11:205. [PMID: 28754171 PMCID: PMC5534056 DOI: 10.1186/s13256-017-1361-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 06/22/2017] [Indexed: 12/03/2022] Open
Abstract
Background Open injuries to the face involving the external carotid artery are uncommon. These injuries are normally associated with laceration of the facial nerve because this nerve is more superficial than the external carotid artery. Hence, external carotid artery lesions are usually associated with facial nerve dysfunction. We present an unusual case report in which the patient had an injury to this artery with no facial nerve compromise. Case presentation A 25-year-old Portuguese man sustained a stab wound injury to his right preauricular region with a broken glass. Immediate profuse bleeding ensued. Provisory tamponade of the wound was achieved at the place of aggression by two off-duty doctors. He was initially transferred to a district hospital, where a large arterial bleeding was observed and a temporary compressive dressing was applied. Subsequently, the patient was transferred to a tertiary hospital. At admission in the emergency room, he presented a pulsating lesion in the right preauricular region and slight weakness in the territory of the inferior buccal branch of the facial nerve. The physical examination suggested an arterial lesion superficial to the facial nerve. However, in the operating theater, a section of the posterior and lateral flanks of the external carotid artery inside the parotid gland was identified. No lesion of the facial nerve was observed, and the external carotid artery was repaired. To better understand the anatomical rationale of this uncommon clinical case, we dissected the preauricular region of six cadavers previously injected with colored latex solutions in the vascular system. A small triangular space between the two main branches of division of the facial nerve in which the external carotid artery was not covered by the facial nerve was observed bilaterally in all cases. Conclusions This clinical case illustrates that, in a preauricular wound, the external carotid artery can be injured without facial nerve damage. However, no similar description was found in the reviewed literature, which suggests that this must be a very rare occurrence. According to the dissection study performed, this is due to the existence of a triangular space between the cervicofacial and temporofacial nerve trunks in which the external carotid artery is not covered by the facial nerve or its branches.
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Affiliation(s)
- Diogo Casal
- Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal. .,Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal.
| | - Giovanni Pelliccia
- Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.,Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal
| | - Diogo Pais
- Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.,Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal
| | - Diogo Carrola-Gomes
- General Surgery Department, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Maria Angélica-Almeida
- Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.,Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal
| | - José Videira-Castro
- Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - João Goyri-O'Neill
- Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal
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17
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Pérez Pérez S, Belinchón de Diego A, Santos Alcántara E, Juliá Molla E, Almodóvar Álvarez C. Disección carotídea secundaria a herida cervical por arma de fuego. ANGIOLOGIA 2017. [DOI: 10.1016/j.angio.2016.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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18
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Abstract
The management of gunshot wounds is an increasing problem for UK emergency doctors, but not to an extent where it has become routine or allowed individuals to gain significant experience in their treatment. This article reviews the pathophysiology of gunshot injury in general before examining the evidence available concerning the management of gunshot wounds to the head neck and thorax.
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Affiliation(s)
- Jeff Garner
- Chesterfield Royal Hospital, Calow, Chesterfield, Derbyshire, UK,
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19
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Dwivedi AJ, Cherukupalli C, Dayal R, Krishansastry KV. Endovascular Treatment of False Aneurysm of the Thyrocervical Trunk. Vasc Endovascular Surg 2016; 41:77-9. [PMID: 17277248 DOI: 10.1177/1538574406290075] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The thyrocervical trunk is the second superior branch off the subclavian artery. Pseudoaneurysm of the thyrocervical trunk has been reported after attempted internal jugular vein cannulation for central venous or hemodialysis access. The treatment of pseudoaneurysms of the thyrocervical trunk depends on the findings from color flow Doppler ultrasonography and angiography. Although pseudoaneurysms of the thyrocervical trunk are rare, the treatment options should be clear. Surgical ligation is an effective technique that is safe and well-defined, but control through a cervical incision may be difficult. Endovascular treatment of the pseudoaneurysm may be accomplished with coil embolization of the artery, which is described.
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Affiliation(s)
- Amit J Dwivedi
- Department of Vascular Surgery, North Shore University and Long Island Jewish Medical Centers, Manhasset, New York.
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20
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Marston AP, Montenegro MM, Oldenburg MS, Thom JT, Driscoll CL. A unique case of penetrating neck and cervical spine trauma resulting in vertebral artery transection and internal carotid artery laceration. Am J Otolaryngol 2016; 37:199-201. [PMID: 27178507 DOI: 10.1016/j.amjoto.2016.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 01/18/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Describe the presentation and treatment of a patient who suffered a penetrating cervical trauma resulting in occlusion of the vertebral and internal carotid arteries. METHODS The electronic medical record was used to collect information pertaining to the patient's clinical history. RESULTS A 20-year-old male suffered a unique penetrating neck injury resulting in simultaneous injuries to the internal carotid and vertebral arteries as demonstrated by pre-operative angiography. Combined endovascular and open surgical approaches were utilized to successfully manage the vascular injuries prior to foreign body extraction. CONCLUSION Complex penetrating cervical trauma is best managed with a multidisciplinary and multimodality approach. In appropriately selected patients, pre-operative angiography is a critical diagnostic modality that can prevent life-threatening hemorrhage following foreign body extraction.
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22
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Tallon JM, Ahmed JM, Sealy B. Airway management in penetrating neck trauma at a Canadian tertiary trauma centre. CAN J EMERG MED 2015; 9:101-4. [PMID: 17391580 DOI: 10.1017/s148180350001486x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACT
Objectives:
The optimal approach to airway management in penetrating neck injuries (PNIs) remains controversial. The primary objective of this study was to review the method of endotracheal intubation in PNI at a Canadian tertiary trauma centre. Secondarily, we sought to determine the incidence of PNI in our trauma population and to describe the epidemiologic elements of this population.
Methods:
We conducted a review of patients with PNIs who were enrolled in the Nova Scotia Trauma Registry database. We included all patients 16 years of age or under who presented between April 1, 1994 and March 31, 2005 with penetrating injuries of the neck and an Injury Severity Score (ISS) of 9 or less or who underwent Trauma Team activation at our Tertiary Trauma Centre (regardless of ISS) and/or who were identified upon admission as a “major” trauma case. The variables of interest were patient age and sex, injury mechanism, injury location, place of intubation and method of intubation.
Results:
There were 19 people who met inclusion criteria and they were enrolled in our study. The injury mechanisms involved knife (n = 13) or gunshot (n = 5) wounds (one patient's injuries were categorized as “other”). Three patients (15.8%) were not intubated. The remaining 16 patients were intubated during prehospital care (n = 5), in the emergency department (n = 6) or in the operating room (n = 5). Of these, 8 patients (42.1%) underwent awake intubation and 8 (42.1%) underwent rapid sequence intubation.
Conclusion:
There is clear variability of airway management in PNI. We believe that such patients represent a heterogeneous group where the attending physician must have a conservative yet varied approach to airway management based on the individual clinical scenario.
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Affiliation(s)
- John M Tallon
- Department of Emergency Medicine, Dalhousie University, Halifax, NS.
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23
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24
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Alderazi YJ, Cruz GM, Kass-Hout T, Prestigiacomo CJ, Duffis EJ, Gandhi CD. Endovascular therapy for cerebrovascular injuries after head and neck trauma. TRAUMA-ENGLAND 2015. [DOI: 10.1177/1460408615573884] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cerebrovascular injuries after blunt or penetrating head and neck trauma often lead to significant disability from ischemic stroke, hemorrhagic stroke and uncontrolled extracranial hemorrhage. Trauma causes carotid or vertebral dissection, occlusion, pseudoaneurysm, arteriovenous fistula, vessel transection, traumatic epistaxis, venous sinus thrombosis and carotid cavernous fistula. The rapid development of neuroendovascular techniques over the past two decades has led to effective therapies for each of these injuries. Controlled lesion embolization may use coils, liquid embolics (onyx or n-butyl cyanoarcrylate), polyvinyl alcohol particles or detachable balloons; there is stent angioplasty with uncovered, overlapping and covered stents or mechanical thrombolysis using stent-retrievers or aspiration catheters and the use of balloon occlusion tests and supraselective angiography to delineate safety of vessel sacrifice and to diagnose occult lesions respectively. Furthermore, the proliferation of stroke centers has increased local availability of rapid neuroendovascular expertise at many major trauma centers. Neuroendovascular therapies are less invasive than surgery, can often preserve the injured parent vessels and aid in treating conditions where surgery may be limited. In the absence of randomized controlled trials we present a narrative review of current endovascular therapeutic applications for each of these injuries. This expands the therapies at trauma teams' disposal in the continued effort to control bleeding, reduce secondary injury and prevent disability after trauma. Further research is necessary to inform the role of endovascular techniques after trauma. In particular, comparative studies are necessary to quantify the risk and benefits in conditions where surgical options also exist.
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Affiliation(s)
- Yazan J Alderazi
- Endovascular Neurosurgery, Department of Neurological Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA
| | - Ghislaine M Cruz
- Endovascular Neurosurgery, Department of Neurological Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA
| | - Tareq Kass-Hout
- Endovascular Neurosurgery, Department of Neurological Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA
| | - Charles J Prestigiacomo
- Endovascular Neurosurgery, Department of Neurological Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA
| | - E Jesus Duffis
- Neurointerventional Surgery, Department of Neurology, Baystate Medical Center, Springfield, MA, USA
| | - Chirag D Gandhi
- Endovascular Neurosurgery, Department of Neurological Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA
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Trap-door incision for penetrating thoracic trauma: an obsolete approach? Case Rep Surg 2014; 2014:798242. [PMID: 25165611 PMCID: PMC4137611 DOI: 10.1155/2014/798242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 07/12/2014] [Indexed: 11/18/2022] Open
Abstract
Penetrating injuries to the subclavian vessels are uncommon and very severe lesions. They are difficult to expose and carry a high mortality. "Trap-door" incisions have lately been dismissed as too mutilating for the occasional victim of a penetrating thoracic trauma with massive bleeding difficult that is to expose. We present a case of severe bleeding from a stab wound in the left subclavicular area in a heavy-built patient where a "trap-door" incision proved inevitable to expose and repair the injury, and most probably saved his life.
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26
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Lee TS, Ducic Y, Gordin E, Stroman D. Management of carotid artery trauma. Craniomaxillofac Trauma Reconstr 2014; 7:175-89. [PMID: 25136406 DOI: 10.1055/s-0034-1372521] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
With increased awareness and liberal screening of trauma patients with identified risk factors, recent case series demonstrate improved early diagnosis of carotid artery trauma before they become problematio. There remains a need for unified screening criteria for both intracranial and extracranial carotid trauma. In the absence of contraindications, antithrombotic agents should be considered in blunt carotid artery injuries, as there is a significant risk of progression of vessel injury with observation alone. Despite CTA being used as a common screening modality, it appears to lack sufficient sensitivity. DSA remains to be the gold standard in screening. Endovascular techniques are becoming more widely accepted as the primary surgical modality in the treatment of blunt extracranial carotid injuries and penetrating/blunt intracranial carotid lessions. Nonetheless, open surgical approaches are still needed for the treatment of penetrating extracranial carotid injuries and in patients with unfavorable lesions for endovascular intervention.
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Affiliation(s)
- Thomas S Lee
- Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas ; Department of Otolaryngology-Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Eli Gordin
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - David Stroman
- Division of Vascular Surgery, John Peter Smith Hospital, Fort Worth, Texas
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Gilyoma JM, Hauli KA, Chalya PL. Cut throat injuries at a university teaching hospital in northwestern Tanzania: a review of 98 cases. BMC Emerg Med 2014; 14:1. [PMID: 24423426 PMCID: PMC3893495 DOI: 10.1186/1471-227x-14-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 01/06/2014] [Indexed: 11/16/2022] Open
Abstract
Background Cut throat injuries though rarely reported in literature pose a great therapeutic challenge because multiple vital structures are vulnerable to injuries in the small, confined unprotected area. A sudden increase in the number of cut throat patients in our centre in recent years prompted the authors to analyze this problem. This study was conducted in our local setting to describe the etiology, patterns and treatment outcome of these injuries. Methods This was a combined retrospective and prospective study of cut throat injury patients who were managed at Bugando Medical Centre between February 2009 and January 2013. Statistical data analysis was done using SPSS software version 17.0. Results A total of 98 patients with cut throat injuries were studied. Males outnumbered females by a ratio of 2.4: 1. The median age of patients was 26 years (range 8 to 78 years). Majority of patients (79.6%) had no employment and most of them (65.3%) came from rural community. Homicide was the commonest (55.1%) cause, followed by suicidal attempts (34.7%) and accidental (10.2%) injuries. Interpersonal conflict (24.4%) was the most common motivating factor for homicidal injury whereas psychiatric illness (16.2%) and road traffic accidents (9.2%) were the most frequent motivating factors of suicidal attempt and accidental injuries respectively. The majority of injuries were in Zone II accounting for 65.3% of cases and most of them had laryngeal (57.1%) injury. Surgical debridement, laryngeal/hypopharynx repair and tracheostomy were the most common surgical procedures performed in 93.9%, 73.5% and 70.4% of patients respectively. Postoperative complication rate was 57.1%, the commonest being surgical site infections in 28.1% of patients and it was significantly associated with late presentation and anatomical zones (P < 0.001). The overall median duration of hospitalization was 12 days. Patients who had postoperative complications stayed longer in the hospital and this was statistically significant (p = 0.011). Mortality rate was 11.2% and was significantly associated with co-morbidities, delayed presentation and presence of complications (p < 0.001). The follow up of patients was poor. Conclusions Cut throat injuries are a major cause of morbidity and mortality among young adult males in our setting. Addressing the root causes of violence such as poverty, unemployment, and substance abuse will reduce the incidence of these injuries in our environment.
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Affiliation(s)
| | | | - Phillipo L Chalya
- Department of Surgery, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania.
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Kaya KH, Koç AK, Uzut M, Altintaş A, Yeğin Y, Sayın I, Kayhan FT. Timely management of penetrating neck trauma: Report of three cases. J Emerg Trauma Shock 2013; 6:289-92. [PMID: 24339665 PMCID: PMC3841539 DOI: 10.4103/0974-2700.120382] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Accepted: 03/06/2013] [Indexed: 11/04/2022] Open
Abstract
In head and neck surgery, penetrating neck injuries are uncommon. The neck contains many important structures, so such trauma can cause significant morbidity and mortality. A patient with penetrating neck trauma should be examined promptly in the emergency room. If possible, damaged tissue and organ fragments should be preserved carefully.
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Affiliation(s)
- Kamil Hakan Kaya
- Department of Otorhinolaryngology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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Van Waes OJ, Cheriex KCAL, Navsaria PH, van Riet PA, Nicol AJ, Vermeulen J. Management of penetrating neck injuries. Br J Surg 2012; 99 Suppl 1:149-54. [PMID: 22441870 DOI: 10.1002/bjs.7733] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Routine surgical exploration after penetrating neck injury (PNI) leads to a large number of negative neck explorations and potential iatrogenic injury. Selective non-operative management (SNOM) of PNI is gaining favour. The present study assessed the feasibility of SNOM in PNI. METHODS Seventy-seven consecutive patients with PNI presenting to a tertiary trauma centre were included in this prospective study from September 2009 to December 2009. All patients were managed according to Advanced Trauma Life Support guidelines, and either underwent emergency surgery or were managed without surgery, based on clinical presentation and/or outcome of special investigations. RESULTS Eight patients (10 per cent) were haemodynamically unstable at presentation. Foley catheter balloon tamponade (FCBT) was successful in stopping active bleeding in six of these patients, and diagnostic angiography revealed an arterial injury in five. The remaining 69 patients were managed using SNOM. Angiography or computed tomography was done in 41 patients (53 per cent), and showed arterial injury in 15. These injuries were treated surgically (7 patients), radiologically (stenting in 3) or conservatively. Contrast swallow and/or endoscopy were performed in 37 patients (48 per cent) for suspected oesophageal injury, but yielded no positive results. During follow-up no missed injuries were detected. CONCLUSION FCBT was useful in patients with PNI and active bleeding. Stable patients should undergo additional investigation based on clinical findings only.
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Affiliation(s)
- O J Van Waes
- Departments of Trauma Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Ohta H, Natarajan SK, Hauck EF, Khalessi AA, Siddiqui AH, Hopkins LN, Levy EI. Endovascular stent therapy for extracranial and intracranial carotid artery dissection: single-center experience. J Neurosurg 2011; 115:91-100. [DOI: 10.3171/2011.1.jns091806] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The objective of this study was to evaluate endovascular stent therapy for carotid artery dissections (CADs).
Methods
Retrospective review of data at Millard Fillmore Gates Hospital identified 43 patients with 44 CADs (intracranial and/or extracranial) treated with carotid artery (CA) stent placement between January 2000 and June 2009.
Results
Thirty-two CADs were spontaneous and 12 were traumatic; 35 were symptomatic. Lesion locations included the extracranial internal CA (ICA; 24 cases), extracranial ICA with common CA involvement (4 cases), and extracranial ICA–intracranial ICA (16 cases). Carotid artery occlusion was 100% in 15 cases (34.1%), 99% in 6 cases (13.6%), 70%–98% in 13 cases (29.5%), and < 70% in 10 cases (22.7%). Five patients suffered pseudoaneurysms. Stent deployment was successful in 43 (97.7%) of 44 cases. The mean pretreatment score on the National Institutes of Health Stroke Scale was 6.2 ± 6.2. Recanalization (Thrombolysis in Myocardial Infarction Grade 2 or 3) was accomplished for 42 lesions (95.5%). Four patients demonstrated residual parent vessel stenosis (10%–50% in severity). Procedure-related complications occurred in 7 patients and included middle cerebral artery embolism (1 patient), intracranial hemorrhage (2 patients), worsening of dissection (1 patient), stent malpositioning (1 patient), embolic protection filter overload (1 patient), and filter retrieval device fracture (1 patient). Only 2 of these complications caused permanent deficits: the embolism caused a minor but permanent neurological deficit, and 1 intracranial hemorrhage was fatal. At discharge, 36 patients (83.7%) had modified Rankin Scale scores of 0–2 (favorable outcome). During the follow-up interval (mean 19.2 months, range 4–92 months), no patient suffered a new stroke and 1 patient died secondary to preexisting chronic renal failure. In 20 patients with angiographic follow-up, permanent resolution of the dissection was noted in 90.5%; 2 lesions (9.5%) required retreatment.
Conclusions
Endovascular stent-assisted repair of extra- and intracranial CAD was safe and effective in this experience and can be recommended for selected patients. In particular, patients with symptomatic CADs that are not responsive to medical therapy should be considered for interventional treatment.
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Affiliation(s)
- Hajime Ohta
- 1Departments of Neurosurgery and
- 3Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; and
- 4Department of Neurosurgery, Millard Fillmore Gates Hospital, Kaleida Health, Buffalo, New York
| | - Sabareesh K. Natarajan
- 1Departments of Neurosurgery and
- 3Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; and
- 4Department of Neurosurgery, Millard Fillmore Gates Hospital, Kaleida Health, Buffalo, New York
| | - Erik F. Hauck
- 1Departments of Neurosurgery and
- 3Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; and
- 4Department of Neurosurgery, Millard Fillmore Gates Hospital, Kaleida Health, Buffalo, New York
| | - Alexander A. Khalessi
- 1Departments of Neurosurgery and
- 3Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; and
- 4Department of Neurosurgery, Millard Fillmore Gates Hospital, Kaleida Health, Buffalo, New York
| | - Adnan H. Siddiqui
- 1Departments of Neurosurgery and
- 2Radiology, and
- 3Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; and
- 4Department of Neurosurgery, Millard Fillmore Gates Hospital, Kaleida Health, Buffalo, New York
| | - L. Nelson Hopkins
- 1Departments of Neurosurgery and
- 2Radiology, and
- 3Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; and
- 4Department of Neurosurgery, Millard Fillmore Gates Hospital, Kaleida Health, Buffalo, New York
| | - Elad I. Levy
- 1Departments of Neurosurgery and
- 2Radiology, and
- 3Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; and
- 4Department of Neurosurgery, Millard Fillmore Gates Hospital, Kaleida Health, Buffalo, New York
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Lee CH, Park JS, Hwang KW, Lee SW, Park SW, Park SJ. Procedure-Induced Acute Common Carotid Artery Perforation Presenting With Airway Obstruction and Successful Treatment by Endovascular Stent Graft. Korean Circ J 2011; 41:405-8. [PMID: 21860644 PMCID: PMC3152737 DOI: 10.4070/kcj.2011.41.7.405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Accepted: 03/14/2011] [Indexed: 11/30/2022] Open
Abstract
A 63-year-old female was admitted to our hospital for catheter ablation during atrial fibrillation. After catheter ablation, the patient was transferred to the cardiac care unit and mechanically ventilated due to dyspnea and hypotension. Imaging showed active bleeding from the right common carotid artery (CCA) with extensive hematoma into the mediastinum. She was successfully treated with a stent graft at the CCA. Further bleeding or neurologic sequel did not occur after treatment.
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Affiliation(s)
- Chang Hoon Lee
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jong Seon Park
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ki Won Hwang
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung-Whan Lee
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seong-Wook Park
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung-Jung Park
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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The epidemiology of BCVI at a single state trauma centre. Injury 2010; 41:929-34. [PMID: 20362981 DOI: 10.1016/j.injury.2010.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Revised: 02/11/2010] [Accepted: 03/08/2010] [Indexed: 02/02/2023]
Abstract
BACKGROUND Blunt carotid and vertebral artery injury (BCVI) is a relatively uncommon but potentially devastating injury. The aim of our study was to highlight the incidence, patterns, presentation and associations of BCVI at our institution. METHODS Retrospective data between 1st January 2003 and 31st December 2006 was obtained from The Alfred Hospital's health information system, patient medical records and the Department of Neurosurgery's database. Injuries were graded using the Denver grading scale. RESULTS 67 patients (0.64%) out of 10,417 minor and major trauma admissions, were diagnosed with BCVI. 33 (49%) sustained blunt carotid and 34 (51%) sustained blunt vertebral injuries. Motor vehicle accident (MVA) was the cause in 43 out of 67. 35% had associated head injury whilst 57% had concurrent cervical spine fractures. Odds ratio analysis showed that MVA victims with concomitant upper cervical spine injury were 22.9 times more likely to suffer BCVI than those without such risk factors. Approximately 50% of patients had a Glasgow coma score of 14 or less (GCS < or = 14). Grade 4 BCVI was most common. Stroke occurred in 22 (32%) and mortality in 14 (20%). CONCLUSION BCVI although infrequent, is a serious injury. Our study suggests that MVA patients with cervical spine fractures especially of the upper C-spine are at much higher risk of BCVI than those without such injuries.
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Lesiones vasculares del cuello. ANGIOLOGIA 2010. [DOI: 10.1016/s0003-3170(10)70037-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ezzat A, EI Tayeb Y, Mohammad T, Essam F, Hassanin A, Ahmad A, Sebastian M. Experienced Airway Management in Laryngotracheal Injuries: Series of Cases, Survey and Review of Literature. Qatar Med J 2010. [DOI: 10.5339/qmj.2010.1.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Definitive airway control of penetrating laryngotracheal injury can be an extremely difficult challenge for the emergency physician. We report three serious cases of penetrating neck trauma with laryngeal injury that were managed successfully using different techniques of airway control in the Emergency Department (ED) of Hamad General Hospital during the three years from January 2006 through December 2008. Individualized assessment, identification of type of injury and familiarity with airway control techniques and the available options assure timely, safe and proper airway control in such injuries. Choice of technique in penetrating laryngotracheal injury is multifactorial and depends upon case presentation, physician preference, skill, and clinical constraints. The incidence of neck injury during this period was lower than in other reports; being 0.07 % of total trauma cases, while the incidence of penetrating neck injuries represented 17.6% of total neck injuries with no deaths. Implications Statement: Familiarity and availability of variant airway management techniques and variant surgical interventions in penetrating laryngotracheal injuries, improve outcome and reduce mortality.
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Affiliation(s)
| | | | | | | | | | - A. Ahmad
- ****Departments of Trauma Hamad Medical Corporation, Doha, Qatar
| | - M. Sebastian
- *Departments of Anesthesia
- **Departments of Emergency
- ***Departments of ORL-HNS
- ****Departments of Trauma Hamad Medical Corporation, Doha, Qatar
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Imaging of traumatic arterial injuries in the neck with an emphasis on CTA. Emerg Radiol 2009; 17:109-22. [PMID: 19798524 DOI: 10.1007/s10140-009-0835-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Accepted: 09/09/2009] [Indexed: 12/14/2022]
Abstract
Arterial injuries in the neck may be secondary to blunt or penetrating trauma. Because of clinical difficulties in early identification of these injuries as well as their potentially catastrophic consequences, imaging is indispensible in the diagnosis of arterial injuries in the neck. Computed tomography angiography (CTA) has become the initial study of choice in management of these patients. We review the clinical and imaging features of vascular injuries of the neck with special emphasis on CTA.
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Penetrating vertebral artery pseudoaneurysm: a novel endovascular stent graft treatment with artery preservation. ACTA ACUST UNITED AC 2009; 67:E78-81. [PMID: 19741379 DOI: 10.1097/ta.0b013e3181589fb6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Talving P, DuBose J, Barmparas G, Inaba K, Demetriades D. Role of Selective Management of Penetrating Injuries in Mass Casualty Incidents. Eur J Trauma Emerg Surg 2009; 35:225-39. [PMID: 26814899 DOI: 10.1007/s00068-008-8153-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2008] [Accepted: 12/08/2008] [Indexed: 12/19/2022]
Abstract
Terrorist violence has emerged as an increasingly common cause of mass casualty incidents (MCI) due to the sequelae of explosive devices and shooting massacres. A proper emergency medical system disaster plan for dealing with an MCI is of paramount importance to salvage lives. Because the number of casualties following a MCI is likely to exceed the medical resources of the receiving health care facilities, patients must be appropriately sorted to establish treatment priorities. By necessity, clinical signs are likely to prove cornerstones of triage during MCI. An appropriate and effective application of experiences learned from the use of selective nonoperative management (SNOM) techniques may prove essential in this triage process. The present appraisal of the available literature strongly supports that the appropriate utilization of these clinical indicators to identify patients appropriate for SNOM is essential, critical, and readily applicable. We also review the initial emergent triage priorities for penetrating injuries to the head, neck, torso, and extremities in a mass casualty setting.
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Affiliation(s)
- Peep Talving
- Division of Trauma Surgery and Surgical Critical Care, University of Southern California, USC + LAC Medical Center, 1200 North State Street, Room 9900, Los Angeles, CA, 90033, USA.
| | | | | | | | - Demetrios Demetriades
- Division of Trauma Surgery and Surgical Critical Care, University of Southern California, USC + LAC Medical Center, Los Angeles, USA
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Endovascular stenting for the treatment of traumatic internal carotid injuries: expanding experience. ACTA ACUST UNITED AC 2009; 65:1561-6. [PMID: 19077655 DOI: 10.1097/ta.0b013e31817fd954] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The role of endovascular techniques in the treatment of traumatic vascular injuries, including injury to the internal carotid artery, continues to evolve. Despite growing experience with the usage of these techniques in the setting of artherosclerotic disease, published results in traumatic carotid injuries remain sporadic and confined to case reports and case series. METHODS We conducted a review of the medical literature from 1990 to the present date using the Pubmed and OVID Medline databases to search for all reports documenting the use of endovascular stenting for the treatment of carotid injuries. Thirty-one published reports were analyzed to abstract data regarding mechanism, location, and type of injury; use and type of anticoagulation used in conjunction with stenting; type and timing of radiographic and clinical follow-up; and radiographic and clinical outcomes. RESULTS The use of endovascular stenting for the treatment of internal carotid injuries was reported for only 113 patients from 1994 to the present date. Stenting was most commonly used after a blunt mechanism of injury (77.0%). The injury types treated by stenting included pseudoaneurysm (60.2%), arteriovenous fistula (16.8%), dissection (14.2%), partial transection (4.4%), occlusion (2.7%), intimal flap (0.9%), and aneurysm (0.9%). Initial endovascular stent placement was successful in 76.1% of patients. Radiographic and clinical follow-up periods ranging from 2 weeks to 2 years revealed a follow-up patency of 79.6%. No stent-related mortalities were reported. New neurologic deficits after stent placement occurred in 3.5%. CONCLUSION Endovascular treatment of traumatic internal carotid artery injury continues to evolve. Early results are encouraging, but experience with this modality and data on late follow-up are still very limited. A large prospective randomized trial is warranted to further define the role of this treatment modality in the setting of trauma.
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Kesser BW, Chance E, Kleiner D, Young JS. Article Commentary: Contemporary Management of Penetrating Neck Trauma. Am Surg 2009. [DOI: 10.1177/000313480907500101] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Bradley W. Kesser
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Elizabeth Chance
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Daniel Kleiner
- Department of General Surgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Jeffrey S. Young
- Department of General Surgery, University of Virginia Medical Center, Charlottesville, Virginia
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Magge D, Farber A, Vladimir F, Woodson J, Collins K, Shaw P, Gibbons G. Diagnosis and Management of Traumatic Pseudoaneurysm of the Carotid Artery: Case Report and Review of the Literature. Vascular 2008; 16:350-5. [DOI: 10.2310/6670.2008.00047] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Injury to the carotid artery can occur in the setting of blunt and penetrating trauma. Such injury can result in pseudoaneurysm formation. We present a case of posttraumatic common carotid pseudoaneurysm (PTCP) that was diagnosed and treated 2 months after a motor vehicle accident and review the literature on the presentation, diagnosis, and management of PTCP.
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Affiliation(s)
- Deepa Magge
- *Section of Vascular Surgery, Boston Medical Center, Boston, MA; †Section of Vascular Surgery, St. Vincent's Medical Center, New York, NY
| | - Alik Farber
- *Section of Vascular Surgery, Boston Medical Center, Boston, MA; †Section of Vascular Surgery, St. Vincent's Medical Center, New York, NY
| | - Felix Vladimir
- *Section of Vascular Surgery, Boston Medical Center, Boston, MA; †Section of Vascular Surgery, St. Vincent's Medical Center, New York, NY
| | - Jonathan Woodson
- *Section of Vascular Surgery, Boston Medical Center, Boston, MA; †Section of Vascular Surgery, St. Vincent's Medical Center, New York, NY
| | - Kathryn Collins
- *Section of Vascular Surgery, Boston Medical Center, Boston, MA; †Section of Vascular Surgery, St. Vincent's Medical Center, New York, NY
| | - Palma Shaw
- *Section of Vascular Surgery, Boston Medical Center, Boston, MA; †Section of Vascular Surgery, St. Vincent's Medical Center, New York, NY
| | - Gary Gibbons
- *Section of Vascular Surgery, Boston Medical Center, Boston, MA; †Section of Vascular Surgery, St. Vincent's Medical Center, New York, NY
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Lin HL, Lin YK, Kuo LC, Lee WC, Chen CW, Lin JN. Damage control in the transection of carotid artery--a case report. Am J Emerg Med 2008; 26:841.e3-5. [PMID: 18774065 DOI: 10.1016/j.ajem.2008.01.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2007] [Accepted: 01/28/2008] [Indexed: 11/19/2022] Open
Abstract
Transection of the carotid artery is very rare in Taiwan owing to tight gun control. Most carotid artery injuries are caused by penetration wounds as a result of stabbing or shooting. The total transection of internal and external common arteries is very rarely encountered, and most surgeons lack experience of this intervention. We present a very rare patient who had his right neck cut caused by a flying piece of sheet metal during a typhoon. The case was sent to our emergency department without any vital signs. Intubation was performed into the perforation of larynx with aggressive resuscitation. The patient regained his heart rate and blood pressure after several minutes of cardiopulmonary resuscitation. Then he was sent to operating room, where tracheostomy was performed and bleeding was controlled by ligation of all bleeding arteries including internal and external carotid arteries. Two days later, the patient died, however. We reviewed the literatures and discussed the case.
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Affiliation(s)
- Hsing-Lin Lin
- Department of Trauma, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
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Cheema M, Kirton OC, Lukose B, Gallagher J. Ligation of the subclavian artery after blunt trauma presenting as massive hemothorax. ACTA ACUST UNITED AC 2008; 64:1126-30. [PMID: 17413525 DOI: 10.1097/01.ta.0000195726.14064.0f] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Mohiuddin Cheema
- Department of Surgery, Hartford Hospital, University of Connecticut Integrated Surgical Residency, 80 Seymour Street, Hartford, Connecticut, USA
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Fernández-Alonso L, Urtasun F, Jiménez-Arribas J, Alegret J, Atienza-Pascual M, Centeno-Vallepuga R, Barberena J, Aranzadi C. Pseudoaneurisma del tronco tirocervical: tratamiento endovascular. ANGIOLOGIA 2008. [DOI: 10.1016/s0003-3170(08)02013-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Affiliation(s)
- Lindsey A Nelson
- Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0764, USA.
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Pakarinen TK, Leppäniemi A, Sihvo E, Hiltunen KM, Salo J. Management of cervical stab wounds in low volume trauma centres: systematic physical examination and low threshold for adjunctive studies, or surgical exploration. Injury 2006; 37:440-7. [PMID: 16574122 DOI: 10.1016/j.injury.2006.01.044] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2005] [Revised: 01/11/2006] [Accepted: 01/30/2006] [Indexed: 02/02/2023]
Abstract
INTRODUCTION In Nordic countries penetrating neck injuries (PNIs) are infrequent and management has traditionally been guided by surgeons' preferences. Some form of selective non-operative approach is currently practised in most urban trauma centres. OBJECTIVE To examine demographic features and treatment outcome of non-ballistic penetrating neck injuries in southern Finland and provide management guidelines for centres with low volume of penetrating neck trauma. MATERIALS AND METHODS Retrospective analysis of 85 platysma penetrating neck injuries in two southern Finland hospitals (Helsinki University Central Hospital, HUCH and Tampere University Hospital, TaUH) was carried out using the ICD-10 based hospital databases to identify PNI-patients. RESULTS The incidence of admitted patients with penetrating neck injuries was 1.3/100000/year. Fifty-two (61%) injuries were caused by random acts of violence, 28 (38%) were self-inflicted and 5 (6%) were accidents. Of all 85 patients, 52 (61%) underwent operative exploration with a negative exploration rate of 65%. Hard signs for vascular or aerodigestive trauma were present in 23 (27%) patients and all of these were operated with a negative exploration rate of 30%. Two patients had no hard signs on physical examination but were operatively explored and significant injuries were found in both patients. The hospital mortality rate was 0% and the overall complication rate for operated patients was 7.7%. CONCLUSIONS Trauma centres managing PNIs infrequently should have an individually tailored management protocol for penetrating neck injury patients. If mandatory exploration is not practised, a systematic physical examination should be the mainstay of diagnostic work up but the threshold for adjunctive studies should be low. Although not evident by the current data, protocol-based management could be useful in decreasing treatment variation and enhancing residency training.
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Affiliation(s)
- Toni-Karri Pakarinen
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Finland.
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Luqman Z, Khan MAM, Nazir Z. Penetrating pharyngeal injuries in children: trivial trauma leading to devastating complications. Pediatr Surg Int 2005; 21:432-5. [PMID: 15891890 DOI: 10.1007/s00383-005-1447-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2005] [Indexed: 11/25/2022]
Abstract
Pharyngeal perforations are uncommon in children and are usually secondary to instrumentation or external penetrating injuries. A delay in management can lead to life-threatening complications such as retropharyngeal abscess, mediastinitis, and airway compromise. We report three children who had pharyngeal perforation due to apparently innocuous injury and who developed serious complications. A high index of suspicion for a significant pharyngeal injury, use of lateral soft-tissue x-ray films of the neck, and flexible endoscopy in the emergency room can assist in early diagnosis when evaluating patients with oropharyngeal and penetrating neck injury. Prompt administration of broad-spectrum antibiotics, local drainage, and debridement can avert life-threatening complications.
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Affiliation(s)
- Zubair Luqman
- Department of Surgery, The Aga Khan University Hospital, P.O. Box 3500, Stadium Road, Karachi, Pakistan
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du Toit DF, van Schalkwyk GD, Wadee SA, Warren BL. Neurologic outcome after penetrating extracranial arterial trauma. J Vasc Surg 2003; 38:257-62. [PMID: 12891106 DOI: 10.1016/s0741-5214(03)00143-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We undertook this study to determine factors that adversely affect outcome in patients with penetrating injury to the extracranial cerebral vasculature. Patients and methods Medical records were reviewed for all patients who had undergone surgical intervention to treat penetrating injury to the extracranial cerebral arteries between January 1989 and December 1999. Forensic autopsy findings were also reviewed for all patients who died as a result of their injury. RESULTS One hundred fifty-one patients with injury to the brachiocephalic artery (n = 21), common carotid artery (n = 98), or internal carotid artery (n = 32) were identified. Overall mortality was 21.2%, and stroke rate in surviving patients was 15.1%. Twenty-five of 32 deaths (78.1%) were stroke-related. Brachiocephalic artery injury was associated with the highest mortality (38.1%), and survivor stroke rate was highest in patients with internal carotid injuries (22.7%). Hemodynamic instability at presentation led to both higher mortality (30.7%) and stroke rate (19.2%). Preoperative angiography did not influence mortality or stroke rate in hemodynamically stable patients. Procedural mortality associated with arterial ligation was 45% (9 of 20 patients), and no surviving patient experienced a change in pre-ligation neurologic state. Nine patients remained neurologically intact after ligation, and 2 patients with preoperative localized neurologic deficit were unchanged postoperatively. In 131 patients, mortality after arterial repair was 17.6%, and in 5 surviving patients (5.4%) an ischemic neurologic deficit developed. Twelve of 15 surviving patients (80%) with preoperative neurologic deficit who underwent arterial repair had improved neurologic status. Cerebral infarcts were confirmed at autopsy in 23 patients; 18 infarcts were ischemic (10, repair; 8, ligation), and 5 infarcts were hemorrhagic (all, repair). No factor was identified that was predictive of ischemic versus hemorrhagic infarction in patients undergoing repair. CONCLUSIONS The presence of hypovolemic shock, internal carotid artery injury, complete vessel transection, and arterial ligation are associated with unfavorable outcome. Penetrating injury to the brachiocephalic, common carotid, or internal carotid artery should be repaired rather than ligated when technically possible. Subsequent ischemic or hemorrhagic cerebral infarction is unpredictable, but overall outcome is superior to that with ligation of the injured artery.
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Affiliation(s)
- Daniel F du Toit
- Department of Surgery, Tygerberg Hospital, PO Box 19063, Tygerberg 7505, South Africa.
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