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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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2
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Chandrananth ML, Lee JD, Read D, Shakerian R. 'No zone' approach in the management of penetrating neck injuries - an Australian Tertiary Trauma Centre experience. ANZ J Surg 2024; 94:591-596. [PMID: 38525869 DOI: 10.1111/ans.18939] [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: 11/20/2023] [Revised: 01/20/2024] [Accepted: 02/27/2024] [Indexed: 03/26/2024]
Abstract
PURPOSE Penetrating neck injuries (PNIs), defined as deep to the platysma, can result in significant morbidity and mortality. Management has evolved from a zone-based approach to a 'no zone' algorithm, resulting in reduced non-therapeutic neck exploration rates. The aim of this study was to examine PNIs and its management trends in an Australian tertiary trauma centre, to determine if a 'no zone' approach could be safely implemented in this population, as has been demonstrated internationally. METHODOLOGY This was a retrospective observational study at a level 1 adult Australian tertiary trauma centre using prospectively collated data from January 2008 to December 2018. Observed data included age, gender, mechanism of injury, computed tomography angiography (CT-A) use and operative intervention. Patients were examined based on zone of injury and presenting signs - 'hard', 'soft' or 'asymptomatic'. Major outcomes were CT-A usage, positive CT-A correlation with therapeutic neck explorations and negative neck exploration rates. RESULTS This study identified 238 PNI patients, with 204 selected for review. Most injuries occurred in zone 2 (71.6%), with soft signs accounting for 53.4% of cases. Over 10 years, CT-A utilization increased from 55% to 94.1%, with positive CT-As being more likely to yield therapeutic neck explorations. There was a general decreased trend in operative intervention but without a clear reduction in non-therapeutic neck explorations. CONCLUSION Our data suggests similarities with results from around the world, demonstrating that the 'no zone' approach should be considered when managing PNIs, but with clinician discretion in individual cases.
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Affiliation(s)
- Meera L Chandrananth
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Trauma Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Jordan D Lee
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Trauma Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - David Read
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Trauma Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Rose Shakerian
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Trauma Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia
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3
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Hamilton JM, Chan TG, Moore CE. Penetrating Head and Neck Trauma: A Narrative Review of Evidence-Based Evaluation and Treatment Protocols. Otolaryngol Clin North Am 2023; 56:1013-1025. [PMID: 37353366 DOI: 10.1016/j.otc.2023.05.006] [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] [Indexed: 06/25/2023]
Abstract
Penetrating injury to the head and neck accounts for a minority of trauma but significant morbidity in the US civilian population. The 3-zone anatomical framework has historically guided evaluation and management; however, the most current evidence-based protocols favor a no-zone, systems-based approach. In stable patients, a thorough physical examination and noninvasive imaging should be prioritized, with surgical exploration of the head and neck reserved for certain circumstances. Diagnostic and management decisions should be tailored to the mechanism of injury, history, physical examination, experience of personnel, availability of equipment, and clinical judgment.
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Affiliation(s)
- James M Hamilton
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA; Department of Otolaryngology-Head and Neck Surgery, Grady Memorial Hospital, Atlanta, GA, USA.
| | - Tyler G Chan
- Emory University School of Medicine, Atlanta, GA, USA
| | - Charles E Moore
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA; Department of Otolaryngology-Head and Neck Surgery, Grady Memorial Hospital, Atlanta, GA, USA
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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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5
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Amico F, Bendinelli C, Balogh ZJ. Penetrating neck trauma: No zone, no problem? ANZ J Surg 2021; 91:1051-1052. [PMID: 34121290 DOI: 10.1111/ans.16930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 04/27/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Francesco Amico
- Department of Traumatology, John Hunter Hospital, Newcastle, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Cino Bendinelli
- Department of Traumatology, John Hunter Hospital, Newcastle, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Zsolt J Balogh
- Department of Traumatology, John Hunter Hospital, Newcastle, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
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6
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Chandrananth ML, Zhang A, Voutier CR, Skandarajah A, Thomson BNJ, Shakerian R, Read DJ. 'No zone' approach to the management of stable penetrating neck injuries: a systematic review. ANZ J Surg 2021; 91:1083-1090. [PMID: 33480177 DOI: 10.1111/ans.16600] [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: 10/28/2020] [Revised: 01/05/2021] [Accepted: 01/05/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Aim: to review outcomes of the 'no zone' approach to penetrating neck injuries (PNIs) with the advent of high-fidelity computed tomography-angiography (CT-A) in order to determine the most appropriate management for stable PNIs. DESIGN Systematic review. POPULATION Retrospective and prospective cohort studies of patients who sustained penetrating neck trauma, as defined by an injury which penetrates the platysma, and whose initial management involved CT-A evaluation. METHODS An extensive literature search was performed in July 2019 using the following databases: Pubmed Central, EMBASE, Medline and Cochrane CENTRAL. Only studies published in English from the last 15 years were included. RESULTS Nine cohort studies met inclusion criteria. There has been an increase in CT-A focussed evaluation of PNIs in recent years. CT-A is a highly sensitive and specific imaging choice and reduces negative neck exploration rates. A new management algorithm for stable patients involving initial radiological assessment using CT-A, and subsequent selective surgical exploration, is safe and effective. CONCLUSION The results of this review provide level 2A evidence that the 'no zone' approach to PNIs, complemented by CT-A and thorough clinical assessment, is a safe management strategy which reduces negative neck exploration rates.
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Affiliation(s)
- Meera L Chandrananth
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Andrew Zhang
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Catherine R Voutier
- Health Sciences Library, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Anita Skandarajah
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgical Oncology, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,The University of Melbourne Department of Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Benjamin N J Thomson
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgical Oncology, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,The University of Melbourne Department of Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Rezvaneh Shakerian
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - David J Read
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,The University of Melbourne Department of Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
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7
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A Legal and Forensic Medicine Approach to Police Physical Intervention Techniques in High-Risk Situations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082809. [PMID: 32325816 PMCID: PMC7215352 DOI: 10.3390/ijerph17082809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 12/01/2022]
Abstract
Background: The physical intervention techniques (PITs) typically used by the police in troublesome situations are examined in terms of injuring potential depending on whether they target a body zone of high, medium or low vulnerability. Based on legal and forensic considerations, and principles of congruence, opportunity and proportionality, a need exists to favor opponent locking and arrest techniques targeting non-vulnerable zones to minimize the risk of severe damage. Methods: A search of the training manuals for the different kind of law of enforcement officers was carried out. Revision of injuries was available from electronic databases of academic o medical journals. Results: Three different locking and arrest PITs based on operational tactical procedures (OTP) that avoid zones of high or medium vulnerability are proposed. The new techniques use blocking, diverting and grabbing of the upper and lower limbs, followed by dislocation and locking of the same targets. Conclusions: The damaging potential of such PITs was assessed in terms of anatomical region and most were found to have a high risk of severe damage. The alternative PITs proposed here, which rely on OTP, improve in legal and forensic medical terms on existing choices and dramatically reduce the risk of injuring arrestees.
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8
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Respiratory Pathway and Swallowing Management in a Patient With Epiglottis Loss After Life-Threatening Penetrating Laryngeal Trauma. J Craniofac Surg 2018; 29:1912-1913. [PMID: 30192299 DOI: 10.1097/scs.0000000000005012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Laryngeal trauma is a rare but potentially life-threatening injury. Damage to larynx structures may occur in forms of a simple contusion, fractures of the laryngeal cartilage, and may even result in laryngotracheal disjunction depending on the ossification level of the larynx and the severity of the trauma. However, in almost all cases, damaged laryngeal tissue is also observed in the trauma area. Because thyroid cartilage protects the endolaryngeal tissues like a shield against trauma. Epiglottis prevents escape of the food to respiratory tract and directs food to digestive system. In this article, a case of knife attack resulted in deep neck incision with loss of epiglottis in the incision area, the surgical operation, and the postoperative recovery period which had a clinical significance due to loss of epiglottis were presented. To the best of our knowledge, this is the first laryngeal trauma case with loss of epiglottis.
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9
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10
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Imaging Techniques in Emergency Surgeries. Int Anesthesiol Clin 2016; 54:22-38. [PMID: 26655507 DOI: 10.1097/aia.0000000000000086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Rabiou S, Ghalimi J, Lakranbi M, Ouadnouni Y, Smahi M. Plaie trachéale avec hernie de la thyroïde. ANNALES FRANCAISES DE MEDECINE D URGENCE 2016. [DOI: 10.1007/s13341-015-0603-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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12
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Role of computed tomography angiography in the management of Zone II penetrating neck trauma in patients with clinical hard signs. J Trauma Acute Care Surg 2015; 79:943-50; discussion 950. [DOI: 10.1097/ta.0000000000000713] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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13
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Pejkić S, Ilić N, Dragaš M, Dimić A, Končar I, Cvetković S, Davidović L. Indirect surgical management of a penetrating vertebral artery injury. Vascular 2014; 22:468-70. [DOI: 10.1177/1708538114529278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Vertebral artery injury caused by penetrating neck trauma is a rare occurrence. Direct surgical repair is difficult due to anatomy and exposure. Proximal and distal ligation or/and embolization represent the most common management in cases which require intervention. Case report A young man accidentally stabbed in the neck was admitted to the emergency department with active arterial bleeding from the wound. Immediate surgical exploration revealed an isolated injury of the left vertebral artery intraosseous segment. Lesion was managed by proximal segment ligature and distal Fogarty catheter balloon-tamponade. Postoperative angiography excluded the need for further interventions. Balloon-catheter was successfully extracted after 72 hours and patient discharged neurologically intact on postoperative day 7. Fourteen months later, there are no signs of vascular or neurologic complications. Conclusion Balloon-tamponade is a valuable technical adjunct in either temporizing or definitive management of surgically inaccessible vascular trauma.
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Affiliation(s)
- Siniša Pejkić
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Nikola Ilić
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Marko Dragaš
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Andreja Dimić
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Igor Končar
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Slobodan Cvetković
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Lazar Davidović
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
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Lefort H, Cesareo E, Domanski L, Tourtier JP, Tazarourte K. [Penetrating neck injuries: importance of one systematic clinical examination associated with a MDCT angiography]. ACTA ACUST UNITED AC 2014; 33:188-90. [PMID: 24456615 DOI: 10.1016/j.annfar.2013.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- H Lefort
- Service médical d'urgence, brigade de sapeurs-pompiers de Paris, 3, rue Darmesteter, 75013 Paris, France.
| | - E Cesareo
- Samu/Smur 77, rue Freteau de Peny, 77000 Melun, France
| | - L Domanski
- Service médical d'urgence, brigade de sapeurs-pompiers de Paris, 3, rue Darmesteter, 75013 Paris, France
| | - J P Tourtier
- Service médical d'urgence, brigade de sapeurs-pompiers de Paris, 3, rue Darmesteter, 75013 Paris, France
| | - K Tazarourte
- Samu/Smur 77, rue Freteau de Peny, 77000 Melun, France
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15
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Penetrating neck injury to the superior thoracic artery managed by video-assisted thoracoscopic surgery. Case Rep Surg 2013; 2013:413462. [PMID: 23476874 PMCID: PMC3580914 DOI: 10.1155/2013/413462] [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: 12/22/2012] [Accepted: 01/09/2013] [Indexed: 11/17/2022] Open
Abstract
Penetrating trauma to the axillary artery and its branches is uncommon and associated with high morbidity and mortality. Open exploration is mandated in hemodynamically unstable patients, but surgical exposure can be difficult due to the concentration of vital structures and complex anatomy in this region. Computed tomographic angiography is a potential diagnostic modality in hemodynamically stable patients. In these patients, endovascular therapies may provide a feasible means of controlling hemorrhage while minimizing surgical complications. A high incidence of concomitant intrathoracic injury has resulted in an expanding role for video-assisted thoracoscopic surgery. In this paper, we present a case of penetrating injury to the superior thoracic artery that was not amenable to endovascular therapy and was ultimately managed with thoracoscopic surgery.
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Pasley J, Berg RJ, Inaba K. Multidetector Computed Tomographic Angiography (MDCTA) for Penetrating Neck Injuries. Rambam Maimonides Med J 2012; 3:e0016. [PMID: 23908840 PMCID: PMC3678816 DOI: 10.5041/rmmj.10084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Evaluation of patients after penetrating neck injury has evolved over time. Previously, location of injury and symptoms were used to determine management. The contemporary management of penetrating neck injuries relies on physical examination. Patients with hard signs of vascular or aerodigestive tract injury require immediate operation, regardless of location of injury. Those with no signs can be observed. For the remainder with soft signs, multidetector computed tomographic angiography (MDCTA) is a highly sensitive and specific screening modality for evaluating the vasculature and aerodigestive structures in the neck. Utilizing MDCTA, the patient can be safely directed towards operative intervention, observation, or further investigation.
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Affiliation(s)
| | | | - Kenji Inaba
- To whom correspondence should be addressed., E-mail:
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17
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Unstable cervical spine fracture after penetrating neck injury: a rare entity in an analysis of 1,069 patients. ACTA ACUST UNITED AC 2011; 70:870-2. [PMID: 20805776 DOI: 10.1097/ta.0b013e3181e7576e] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The value of cervical spine immobilization after penetrating trauma to the neck is the subject of lively debate. The purpose of this study was to review the epidemiology of unstable cervical spine injuries (CSI) after penetrating neck trauma in a large cohort of patients. METHODS This is a retrospective analysis of patients admitted with penetrating neck injuries to a Level I trauma center from January 1996 through December 2008. A penetrating neck injury was defined as a gunshot wound (GSW) or stab wound (SW) between the clavicles and the base of the skull. Univariate and multivariate analyses were performed to investigate associations between injury mechanisms, the presence of CSI instability, and mortality. Risk factors independently associated with the presence of a CSI were identified. RESULTS A total of 1,069 patients met inclusion criteria, of which 463 patients (43.3%) and 606 patients (56.7%) were sustaining GSW and SW, respectively. Overall, 65 patients (6.1%) were diagnosed with a CSI with a significantly higher incidence after GSWs compared with SWs (12.1% vs. 1.5%; p < 0.001). In four patients (0.4%), the CSI was considered unstable, all of them following GSW. All patients with unstable CSI had obvious neurologic deficits or altered mental status at the time of admission. Risk factors independently associated with the presence of a CSI were GSW to the neck and a Glasgow Coma Scale score ≤8 on admission (R = 0.16). CONCLUSION The overall incidence of unstable CSI after penetrating trauma to the neck is exceedingly low at 0.4%. Following GSW to the neck, an unstable CSI was noted in <1% of patients. After cervical SW, however, no spinal instability was noted precluding the need for spinal precautions in these instances.
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18
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Herrera DA, Vargas SA, Dublin AB. Endovascular treatment of penetrating traumatic injuries of the extracranial carotid artery. J Vasc Interv Radiol 2010; 22:28-33. [PMID: 21109458 DOI: 10.1016/j.jvir.2010.09.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 07/29/2010] [Accepted: 09/15/2010] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To describe the clinical and angiographic results of endovascular therapy for traumatic injuries of the extracranial carotid artery. MATERIALS AND METHODS The clinical and angiographic features of 36 traumatic injuries of the carotid artery during a 12-year period were reviewed. There were 35 male patients (97.2%) and 1 female patient (2.8%) with an average age of 28.8 years (range 13-60 years). Of the 36 lesions of the carotid artery, 29 (80.6%) were the result of gunshot injury, and 7 (19.4%) were secondary to stab wounds. In 24 (66.7%) instances, the injury resulted in a pseudoaneurysm; in 7 (19.4%), in an arteriovenous fistula (AVF); in 4 (11.1%), in a dissection; and in 1 (2.8%), in inactive bleeding. All patients were treated with an endovascular approach using different techniques (balloon occlusion, embolization, or stent deployment). RESULTS Endovascular therapy resulted in documented lesion occlusion in 34 (94.4%) patients. Two patients declined any follow-up postprocedural imaging; however, they have remained asymptomatic. Clinical improvement was documented in 35 (97.2%) patients, and there was one procedure-related complication with fatal consequences. CONCLUSIONS In this series, endovascular techniques were an effective method of treatment. It was possible to use different endovascular reconstructive techniques or parent artery occlusion depending on the degree of vessel damage, with resolution of clinical symptoms and avoidance of surgery in most cases.
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Affiliation(s)
- Diego A Herrera
- Department of Radiology, Neuroradiology Section, Universidad de Antioquia, Hospital Universitario San Vicente de Paul, and CediMed, Medellin, Colombia.
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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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20
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Casey SJ, De Alwis WD. Review article: Emergency department assessment and management of stab wounds to the neck. Emerg Med Australas 2010; 22:201-10. [DOI: 10.1111/j.1742-6723.2010.01285.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Rao J, Messahel A, Grimes K, Sanders K. Elusive penetrating foreign body to the neck causing partial epiglottic airway obstruction. J Craniomaxillofac Surg 2010; 39:37-9. [PMID: 20456968 DOI: 10.1016/j.jcms.2010.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Accepted: 03/10/2010] [Indexed: 10/19/2022] Open
Abstract
We present a case of a penetrating foreign body to the neck, which was difficult to detect, causing partial epiglottic and laryngeal outlet airway obstruction, and subsequent intubation challenges. A systematic approach with rapid access to contrast enhanced CT scanning allowed successful airway and haemorrhage control, removal of a wooden stake from the patient's neck, initially undetected at primary and secondary assessments.
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Affiliation(s)
- Jeethendra Rao
- Maxillofacial Unit, University Hospital of South Manchester, Southmoor Road, Manchester M23 9LT, UK.
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22
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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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23
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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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Priego Jiménez P, Collado Guirao MV, Rojo Blanco R, Grajal Marino R, Rodríguez Velasco G, García Villanueva A. Chyle fistula in right cervical area after thyroid surgery. Clin Transl Oncol 2008; 10:593-6. [PMID: 18796379 DOI: 10.1007/s12094-008-0257-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Thoracic duct injury is an infrequent (1-2.5%) but severe complication after neck surgery, leading to nutritional, metabolic and immunologic deficiencies. We report a case of a 34-year-old woman with a right thoracic duct injury after surgery of a thyroid medullar cancer effectively treated with conservative management (parenteral nutrition and intravenous somatostatin). Optimal treatment of these patients is unclear, without a clear limit between conservative and surgical treatment.
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25
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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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