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Deb T. Management of an Unusual Penetrating Neck Injury with an Iron Rod in a Tertiary Care Centre. Indian J Otolaryngol Head Neck Surg 2023; 75:2488-2491. [PMID: 37636776 PMCID: PMC10447767 DOI: 10.1007/s12070-023-03737-x] [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: 02/18/2023] [Accepted: 03/26/2023] [Indexed: 08/29/2023] Open
Abstract
The majority of the neck injuries are linked either to aggression or self inflicted cut throat or firearm injuries. Here we present a rare case of a penetrating neck injury by an iron rod, which was sustained due to accidental fall at home. A very long, rusted, iron TMT bar about 10 mm diameter, with entangled clothing with hooks on it, had penetrated the neck of the patient from below the mandible in the left side and exited through the oral cavity on the right angle of the mouth. The patient was under alcohol intoxication, however was stable as far as vital signs were concerned. There was no active bleeding or expanding haematoma neither there was any stridor or neurological deficit. The patient was further stabilised and after doing the necessary investigations he was taken up for surgery under general anaesthesia and the rod was successfully removed and the wound repaired. The patient recovered uneventfully and quickly and was discharged on the fifth post operative day. Accidental penetrating neck injuries are not very common and internet search did not reveal many published cases. Penetrating neck injuries are usually attached with high morbidity and mortality, because of damage to great vessels and nerves. A good knowledge of the anatomy and proper assessment of the injury before removal is a prerequisite before removal. With a little bit of courage and adopting a multidisciplinary approach and good computed tomography (CT) scan to assess the injury, such cases can be easily handled.
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Affiliation(s)
- Tanmoy Deb
- Department of ENT and Head & Neck Surgery, Agartala Government Medical College and GB Pant Hospital, Agartala, Tripura 799006 India
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2
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Muacevic A, Adler JR, Kumar A, Anwer M, Kumar D. Atypical Firearm Injury to the Anterior Triangle of the Neck With an Unusual Projectile Trajectory: A Rare Case Report. Cureus 2023; 15:e33875. [PMID: 36819413 PMCID: PMC9933786 DOI: 10.7759/cureus.33875] [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] [Accepted: 01/17/2023] [Indexed: 01/19/2023] Open
Abstract
The use of firearms is increasing in our society, which increases the incidence of gunshot injuries in developing countries like India. Gunshot injuries in the neck regions are significantly associated with high mortality and morbidity because of the major vascular and other vital structures present in the neck. However, it's very rare that a bullet may have a trajectory that passes through the neck region and does not damage the vital structures. We present one such case of gunshot injury to the neck. A 20-year-old male reported to the emergency department after sustaining a gunshot wound to the left anterior cervical region of the neck. On examination, the right sternocleidomastoid muscle was taut and tender to the touch. It is very rare that a bullet injury in the neck without damage to even a single vital structure. The most critical steps in managing patients with high-velocity penetrating injuries to the head and neck region are securing an airway, controlling hemorrhage, and identifying and repairing residual traumatic deformities at the earliest possible key points for the best outcome.
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3
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Pediatric Penetrating Neck Trauma Resulting From a Metal Boat Cleat: A Case Report. J Trauma Nurs 2022; 29:325-329. [DOI: 10.1097/jtn.0000000000000686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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4
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Takahashi T, Kaneko T, Hane A, Ito A, Kawamoto E, Suzumura M, Ueda K, Shinoda M, Ito A, Imai H. Conservative medical management combined with follow-up multidetector computed tomography of tracheobronchial injury caused by penetrating injuries: A case report. Trauma Case Rep 2022; 42:100710. [PMID: 36247879 PMCID: PMC9561913 DOI: 10.1016/j.tcr.2022.100710] [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: 10/02/2022] [Indexed: 11/05/2022] Open
Abstract
Tracheobronchial injury (TBI) associated with penetrating injuries has various clinical symptoms and often requires urgent surgical repair. A tracheal tube and/or placement of a drainage tube combined with multidetector computed tomography (CT) could be used to manage TBI without surgical repair in eligible patients. In this case report, we describe an 86-year-old woman with subcutaneous emphysema and suspected TBI caused by three knife wounds in her neck. After tracheal intubation at a local hospital, she was transferred to our hospital. On admission, she was diagnosed with subcutaneous and mediastinal emphysema due to TBI, as well as bilateral pneumothorax. We adjusted the position of the tracheal tube to a distal location from the TBI, and placed bilateral thoracic drainage tubes by referring to the CT images taken on admission and during the follow-up. The follow-up CT images revealed healing of the TBI. She did not show any worsening of her symptoms and she was successfully extubated on day 10 of her hospital stay. On day 18, she was considered self-reliant and was transferred to her previous hospital. Based on our experience in this case, we believe that ventilation with appropriate sedation, placement of a tracheal tube, and drainage are important conservative therapies for TBI caused by penetrating injuries. CT is also useful for evaluating the status of TBI.
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Affiliation(s)
- Tsuyoshi Takahashi
- Emergency and Critical Care Center, Mie University Hospital, Tsu, Japan,Corresponding author at: Emergency and Critical Care Center, Mie University Hospital, Tsu, Mie 514-8507, Japan.
| | - Tadashi Kaneko
- Emergency and Critical Care Center, Mie University Hospital, Tsu, Japan
| | - Atsuya Hane
- Emergency and Critical Care Center, Mie University Hospital, Tsu, Japan
| | - Asami Ito
- Emergency and Critical Care Center, Mie University Hospital, Tsu, Japan
| | - Eiji Kawamoto
- Emergency and Critical Care Center, Mie University Hospital, Tsu, Japan
| | - Misato Suzumura
- Department of Otorhinolaryngology, Head & Neck Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Koki Ueda
- Department of Otorhinolaryngology, Head & Neck Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Mari Shinoda
- Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan
| | - Atsushi Ito
- Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan
| | - Hiroshi Imai
- Emergency and Critical Care Center, Mie University Hospital, Tsu, Japan
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Ramírez-Morin MA, Vergara-Miranda H, Guerrero-Arroyo AA, Álvarez-Lozada LA, Martínez-Zarazua RO, De la Cruz-de la Cruz C, Vásquez-Fernández F, Muñoz-Maldonado GE. Trauma cervical penetrante: experiencia de un hospital de enseñanza en México. REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.1285] [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. El trauma cervical penetrante es una entidad poco frecuente, con tendencia al alza, de considerable morbimortalidad. Es fundamental conocer su manejo por cirujanos en entrenamiento, quienes en su mayoría son comúnmente los proveedores del tratamiento en las áreas de urgencias. El objetivo de este estudio fue demostrar la experiencia de un centro de trauma en México en el tratamiento de trauma cervical penetrante administrado por cirujanos en entrenamiento.
Métodos. Estudio retrospectivo de pacientes con diagnóstico de trauma cervical penetrante sometidos a exploración cervical entre los años 2014 y 2019. Se identificaron 110 expedientes, se excluyeron 26 por falta de datos indispensables para la investigación y se analizaron los datos de 84 pacientes.
Resultados. El 96,4 % de los pacientes fueron hombres, la mayoría entre 16 y 50 años (83,3 %) y la zona anatómica II fue la más comúnmente lesionada (65,4 %). Las etiologías más frecuentes fueron heridas por arma cortopunzante (67,9 %) y heridas por proyectil de arma de fuego (25 %). El 95 % de los procedimientos fueron realizados por residentes de cuarto y quinto año. La mediana de días de estancia hospitalaria fue de 2 días. La incidencia de complicaciones fue de 9,5 % y la mortalidad de 1,2 %.
Conclusiones. Los cirujanos generales en etapa de formación entrenados en centros de trauma tienen la capacidad de tratar de forma óptima el trauma cervical penetrante sin modificación de las tasas de morbimortalidad descritas en la literatura internacional.
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Choi KK, Cho J, Lee MA, Eun SM, Jeon YB. Successful management of a common carotid artery injury using a Pruitt-F3 Carotid Shunt: a case report. JOURNAL OF TRAUMA AND INJURY 2022. [DOI: 10.20408/jti.2021.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Kong V, Ko J, Cheung C, Lee B, Leow P, Thirayan V, Bruce J, Laing G, Khashram M, Clarke D. Foley Catheter Balloon Tamponade for Actively Bleeding Wounds Following Penetrating Neck Injury is an Effective Technique for Controlling Non-Compressible Junctional External Haemorrhage. World J Surg 2022; 46:1067-1075. [PMID: 35211783 DOI: 10.1007/s00268-022-06474-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The foley catheter balloon tamponade (FCBT) has been widely employed in the management of trauma. This study reviews our cumulative experience with the use of FCBT in the management of patients presenting with a penetrating neck injury (PNI). METHODS A retrospective study was conducted at a major trauma centre in South Africa over a 9-year period from January 2012 to December 2020. All patients who presented with a PNI who had FCBT were included. RESULTS A total of 1581 patients with a PNI were managed by our trauma centre, and 44 (3%) patients had an FCBT. Of the 44 cases of FCBT, stab wounds accounted for 93% (41/44) and the remaining 7% were for gunshot wounds. Seventy-five per cent of all FCBT (33/44) were inserted at a rural hospital prior to transfer to our trauma centre; the remaining 25% (11/44) were inserted in our resuscitation room. The success rate of FCBT was 80% (35/44), allowing further CT with angiography (CTA) to be performed. CTA findings were: 10/35 (29%) positive, 18/35 (51%) negative, and 7/35 (20%) equivocal. Fifteen patients required additional intervention (open surgery or endovascular intervention). The overall morbidity was 14% (6/44). Eighteen per cent required intensive care unit admission. The median length of stay was 1 day. The overall mortality rate was 11% (5/44). CONCLUSION FCBT is a simple and effective technique as an adjunct in the management of major haemorrhage from a PNI. In highly selective patients, it may also be used as definitive management.
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Affiliation(s)
- Victor Kong
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa. .,Trauma Service, Department of Surgery, Auckland City Hospital, Grafton, Auckland, New Zealand.
| | - Jonathan Ko
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Cynthia Cheung
- Department of Surgery, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Bogo Lee
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Priscilla Leow
- Department of Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Varun Thirayan
- Department of Surgery, Waikato Hospital, Hamilton, New Zealand
| | - John Bruce
- Department of Surgery, University of KwaZulu Natal, Durban, South Africa
| | - Grant Laing
- Department of Surgery, University of KwaZulu Natal, Durban, South Africa
| | - Manar Khashram
- Department of Surgery, University of Auckland, Auckland, New Zealand.,Department of Vascular Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Damian Clarke
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa.,Department of Surgery, University of KwaZulu Natal, Durban, South Africa
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8
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Ajiya A, Shuaibu IY, Anka HM. An Audit of Surgical Neck Explorations for Penetrating Neck Injuries in Northwestern Nigeria: Experience from a Teaching Hospital. Niger J Surg 2021; 27:48-54. [PMID: 34012242 PMCID: PMC8112368 DOI: 10.4103/njs.njs_63_20] [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: 05/31/2020] [Revised: 06/12/2020] [Accepted: 06/18/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Penetrating neck injury is a major trauma mechanism present in about 5%–10% of trauma patients with an estimated mortality of 3%–10%. The management of these injuries is dependent on the anatomical level of injury. Objectives: The objective of the study was to document the clinical and operative findings as well as the treatment outcome among our patients who underwent neck exploration for penetrating neck injuries. Materials and Methods: A retrospective review of patients who had neck exploration for penetrating neck injury between January 2012 and December 2018 was done. Results: Thirty-five patients all of whom had surgical neck exploration were included. The age ranged from 15 to 62 years with a male: female of 7.8:1. The mean age was 30.7 years with standard deviation of ± 12.5 years and the peak age of occurrence of 20–29 years. The mechanism of injury was commonly arrow injury in 9 (25.7%) and suicidal cutthroat in 7 (20%) patients. Thirty-two (91.4%) patients presented with stable vital signs. Zone II neck injuries were most prevalent, seen in 23 (65.7%) patients. Laryngeal injury in 7 (20%) and soft-tissue injury in 7 (20%) of the patients were the most common intraoperative findings. The complication rate of 17.1% with a mortality rate of 2.9% was recorded. There was a statistically significant association between the presence of vascular injury and the development of complications after exploration (Chi-square = 5.666, P = 0.017). It was also a significant positive predictor of complication following neck exploration (odds ratio = 0.017, P = 0.048). Conclusion: Male young adults were most involved, commonly from arrow and stab injuries. Although laryngeal and soft-tissue injuries were predominant, vascular injuries were most associated with postoperative complications.
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Affiliation(s)
- Abdulrazak Ajiya
- Department of Otorhinolaryngology, Faculty of Clinical Sciences, College of Health Sciences, Bayero University Kano/Aminu Kano Teaching Hospital, Kano, Kano State, Nigeria
| | - Iliyasu Yunusa Shuaibu
- Department of Surgery, Division of Otorhinolaryngology, Faculty of Clinical Sciences, Ahmadu Bello University/Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Hamza Manir Anka
- Department of Otorhinolaryngology, Aminu Kano Teaching Hospital, Kano, Kano State, Nigeria
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Setiawan E, Shofwan S, Anwar SL, Ovaditya SZ, Rizaldy R, Janitra G. Ultrasound with needle guiding exploration as a real-time modality for exploration of air rifle bullet close to cervical spine: A case report. Int J Surg Case Rep 2021; 81:105730. [PMID: 33714003 PMCID: PMC7957148 DOI: 10.1016/j.ijscr.2021.105730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/03/2021] [Accepted: 03/03/2021] [Indexed: 11/25/2022] Open
Abstract
Real-time imaging modalities are needed while performing surgical exploration of retained foreign body. Ultrasonography offered an ability to visualize retained foreign body in a real-time. Needle guiding ultrasonography is a technique that allows surgeon to extracts the retained foreign body precisely. The combination of a needle guided ultrasonography, and other imaging studies may increase the accuracy of exploration.
Introduction and importance Surgical exploration of retained air rifle bullet at the neck region is challenging because it is difficult to find bullets during exploration and prevent damage to vital structures. A bedside real-time imaging technique is needed to determine the retained bullet's location to the surrounding structures and guiding exploration. Case presentation A 19-year-old male patient was admitted to the emergency department with neck pain after being shot by an air rifle. The patient's vital signs were stable. A small entry wound to the right lateral side of the neck without exit wound was found without neurological symptoms. The cervical X-ray showed the bullet at the third cervical vertebrae level. Surgical exploration was performed with needle-guiding ultrasonography. The bullet is a one-centimeter anterior transverse process of the third cervical vertebra marked by a hyperechoic object. Exploration was done by tracing the needle. Postoperative neurological evaluation was conducted, and no abnormalities were found. Clinical discussion Preoperative imaging modalities are crucial before the surgical exploration of a retained air rifle bullet. X-ray and CT-scan are imaging modalities that are often used as an initial assessment of retained foreign bodies. However, ultrasonography provides advantages over X-ray and CT scan to provide real-time imaging that supports the surgeon while performing surgical exploration. Ultrasonography with needle guiding exploration increases the precise location of a retained air rifle bullet. Conclusion Ultrasonography was a simple and precise real-time imaging modality for identifying and guiding the exploration of a retained air rifle bullet in the neck area.
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Affiliation(s)
- Eko Setiawan
- Department of Surgery, Medical Faculty, Sultan Agung Islamic University / Sultan Agung Islamic Hospital, Semarang, 50164, Indonesia.
| | - Said Shofwan
- Department of Anesthesiology, Medical Faculty, Sultan Agung Islamic University / Sultan Agung Islamic Hospital, Semarang, 50164, Indonesia.
| | - Sumadi Lukman Anwar
- Department of Surgery - Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada / Dr Sardjito Hospital, Yogyakarta, 55281, Indonesia.
| | - Shafira Zahra Ovaditya
- Department of Biomedical Science, Medical Faculty, Sultan Agung Islamic University / Sultan Agung Islamic Hospital, Semarang, 50164, Indonesia.
| | - Rheza Rizaldy
- Department of Biomedical Science, Medical Faculty, Sultan Agung Islamic University / Sultan Agung Islamic Hospital, Semarang, 50164, Indonesia.
| | - Grady Janitra
- Department of Anesthesiology, Medical Faculty, Sultan Agung Islamic University / Sultan Agung Islamic Hospital, Semarang, 50164, Indonesia.
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10
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Bazzout A, Lachkar A, Benfadil D, Tsen AA, El Ayoubi F, Ghailan R. About an unusual penetrating cervical wound:Iron bar. Ann Med Surg (Lond) 2021; 62:197-199. [PMID: 33537128 PMCID: PMC7843356 DOI: 10.1016/j.amsu.2021.01.035] [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: 11/29/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction The majority of cervical wounds are linked to aggressions and attempted autolysis by knives or firearms. Case presentation the story is about a 35 -year-old man admitted to the emergency room for a penetrating cervical wound following an accidental fall in the workplace. The extremely long iron bar (concrete)has penetrated its neck on the right side.upon admission, the patient was conscious,hemodynamically and respiratory stable without sensory-motor deficit. Surgical exploration is urgently decided under general anesthesia, from wich the foreign body is successfully removed.A follow -up examination at 4 months was without particularity. Discussion Penetrating neck injuries caused by objects such as rods or iron bars pose a significantly high risk of serious neurological damage. Penetrating neck injuries can be life-threatening and functional.the extent of the lesions must be assessed precisely before removing the foreign body. Conclusion we report an exceptional case of a penetrating neck wound caused by a concrete iron bar.treatment should always be multidisciplinary and giving priority to vital structures and function. The majority of cervical wounds are linked to aggressions and attempted autolysis by knives or firearms. The management of trauma to the penetrating neck has gone from compulsory exploration of the neck to selective management. The care is multidisciplinary because it calls upon several stakeholders to know: the surgeon of head and neck, vascular surgeon and anesthesiologist and only an early appropriate treatment can reduce the sequel.
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Affiliation(s)
- Asmae Bazzout
- University Hospital Center Mohamed VI, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Azzeddine Lachkar
- University Hospital Center Mohamed VI, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Drissia Benfadil
- University Hospital Center Mohamed VI, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Adil Abdenbi Tsen
- University Hospital Center Mohamed VI, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Fahd El Ayoubi
- University Hospital Center Mohamed VI, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Rachid Ghailan
- University Hospital Center Mohamed VI, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Oujda, Morocco
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11
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Breeze J, Gensheimer WG, DuBose JJ. Penetrating Neck Injuries Treated at a U.S. Role 3 Medical Treatment Facility in Afghanistan During Operation Resolute Support. Mil Med 2020; 186:18-23. [PMID: 33007083 DOI: 10.1093/milmed/usaa252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/24/2020] [Accepted: 07/30/2020] [Indexed: 11/13/2022] Open
Abstract
ABSTRACT
Introduction
Military trauma registries can identify broad epidemiological trends from neck wounds but cannot reliably demonstrate temporal casualty from clinical interventions or differentiate penetrating neck injuries (PNI) from those that do not breach platysma.
Materials and Methods
All casualties presenting with a neck wound to a Role 3 Medical Treatment Facility in Afghanistan between January 1, 2016 and September 15, 2019 were retrospectively identified using the Emergency Room database. These were matched to records from the Operating Room database, and computed tomography (CT) scans reviewed to determine damage to the neck region.
Results
During this period, 78 casualties presented to the Emergency Room with a neck wound. Forty-one casualties underwent surgery for a neck wound, all of whom had a CT scan. Of these, 35/41 (85%) were deep to platysma (PNI). Casualties with PNI underwent neck exploration in 71% of casualties (25/35), with 8/25 (32%) having surgical exploration at Role 2 where CT is not present. Exploration was more likely in Zones 1 and 2 (8/10, 80% and 18/22, 82%, respectively) compared to Zone 3 (2/8, 25%).
Conclusion
Hemodynamically unstable patients in Zones 1 and 2 generally underwent surgery before CT, confirming that the low threshold for exploration in such patients remains. Only 25% (2/8) of Zone 3 PNI were explored, with the high negative predictive value of CT angiography providing confidence that it was capable of excluding major injury in the majority of cases. No deaths from PNI that survived to treatment at Role 3 were identified, lending evidence to the current management protocols being utilized in Afghanistan.
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Affiliation(s)
- John Breeze
- Royal Centre for Defence Medicine, University Hospitals Birmingham, Birmingham, UK
| | - William G Gensheimer
- Warfighter Eye Center, Malcolm Grow Medical Clinics and Surgery Center, Joint Base Andrews, MD, 20762, USA
| | - Joseph J DuBose
- Center for the Sustainment of Trauma and Readiness Skills, R Adams Cowley Shock Trauma Center, Baltimore, MD 21201, USA
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12
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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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13
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Abstract
BACKGROUND Foley catheter balloon tamponade (FCBT) for bleeding penetrating neck injuries (PNIs) is effective. This study aims to audit the technique and outcomes of FCBT. METHODS Adult patients with PNIs requiring FCBT presenting to Groote Schuur Hospital (GSH) within a 22-month study period were prospectively captured on an approved electronic registry. Retrospective analysis included demographics, major injuries, investigations, management and outcomes. RESULTS During the study period, 628 patients with PNI were treated at GSH. In 95 patients (15.2%), FCBT was utilised. The majority were men (98%) with an average age of 27.9 years. Most injuries were caused by stab wounds (90.5%). The majority of catheters (81.1%) were inserted prior to arrival at GSH. Computerised tomographic angiography (CTA) was done in 92.6% of patients, while eight patients (8.4%) required catheter-directed angiography. Six were performed for interventional endovascular management. Thirty-four arterial injuries were identified in 29 patients. Ongoing bleeding was noted in three patients, equating to a 97% success rate for haemorrhage control. Thirteen (13.7%) patients required neck exploration. Seventy-two (75.8%) patients without major arterial injury had removal of the catheter at 48-72 h. Two of these bled on catheter removal. A total of 36 complications were documented in 28 patients (29.5%). There was one death due to uncontrolled haemorrhage from the neck wound. CONCLUSION This large series highlights the ease of use of FCBT with high rates of success at haemorrhage control (97%). Venous injuries and minor arterial injuries are definitively managed with this technique.
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14
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Wang D, Gao CB. Rigid esophagoscopy combined with angle endoscopy for treatment of superior mediastinal foreign bodies penetrating into the esophagus caused by neck trauma: A case report. World J Clin Cases 2019; 7:4130-4136. [PMID: 31832418 PMCID: PMC6906559 DOI: 10.12998/wjcc.v7.i23.4130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/14/2019] [Accepted: 11/19/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Herein, we report a case in whom two foreign bodies entered the upper mediastinal cavity from the cervical root and subsequently the esophagus. Surgery is the preferred treatment method, and operational procedures depend on the size and location of the foreign body relative to the mediastinal vessels. Rigid esophagoscopy combined with angle endoscopic surgery was selected to avoid surgical trauma and complications.
CASE SUMMARY A 63-year-old male patient with a 6-mo old history of neck trauma presented with a black-brown foreign body in the lateral wall of the esophagus. Neck and chest computed tomography (CT) revealed that two superior mediastinal foreign bodies penetrated the esophagus diagonally. We removed two foreign bodies through an esophagoscope. Owing to the rigid working channel of esophagoscope and good exposure of endoscope, the risk of injury to the adjacent vital tissues was minimized. Postoperative comprehensive therapies, including antibiotic administration and nutritional support, resulted in a prompt postoperative recovery. Postoperative CT confirmed the absence of a residual foreign body and neck and chest infections. In addition, upper gastrointestinal angiography and gastroscopy revealed the absence of an evident esophageal perforation. The patient received an oral diet and did not experience any complication at the time of discharge from the hospital.
CONCLUSION Rigid esophagoscopy combined with angle endoscopy is an effective, minimally invasive treatment for penetrating neck injuries.
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Affiliation(s)
- Dong Wang
- Department of Otorhinolaryngology Head and Neck, First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Chao-Bing Gao
- Department of Otorhinolaryngology Head and Neck, First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
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15
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Petrone P, Velaz-Pardo L, Gendy A, Velcu L, Brathwaite CEM, Joseph DK. Diagnosis, management and treatment of neck trauma. Cir Esp 2019; 97:489-500. [PMID: 31358299 DOI: 10.1016/j.ciresp.2019.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/27/2019] [Accepted: 06/02/2019] [Indexed: 11/15/2022]
Abstract
Trauma injuries to the neck account for 5-10% of all trauma injuries and carry a high rate of morbidity and mortality, as several vital structures can be damaged. Currently, there are several treatment approaches based on initial management by zones, initial management not based on zones and conservative management of selected patients. The objective of this systematic review is to describe the management of neck trauma.
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Affiliation(s)
- Patrizio Petrone
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU..
| | - Leyre Velaz-Pardo
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU
| | - Amir Gendy
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU
| | - Laura Velcu
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU
| | - Collin E M Brathwaite
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU
| | - D'Andrea K Joseph
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU
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Wang D, Zhao Y, Cha B, Fang P, Liu Y. Penetrating neck trauma with common carotid artery injury caused by a percussive drill: A case report. Medicine (Baltimore) 2019; 98:e15750. [PMID: 31145290 PMCID: PMC6709122 DOI: 10.1097/md.0000000000015750] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Penetrating neck traumas are dangerous and have a high mortality rate, particularly in patients with common carotid artery injuries. Advances in diagnostic imaging technology have shifted management of penetrating neck injuries from mandatory exploration to selective management. The question is now regarding optimal selection of auxiliary examinations to assess "stability" rapidly and guide clinics in managing such patients. PATIENT CONCERNS A 56-year-old man suffered neck trauma with the right common carotid artery caused by a percussive drill. The carotid artery could not be clearly displayed in computed tomography (CT) angiography imaging. DIAGNOSES Penetrating neck trauma due to percussive drill bit with common carotid artery injury. INTERVENTIONS X-ray and bedside duplex ultrasound with color Doppler flow imaging were used to assess the state of trauma and the foreign body was removed under general anesthesia. OUTCOMES The patient was discharged at postoperative day 10 with no complication. The patient had no sequelae from this injury at 6-month follow up. LESSONS X-ray provides a comprehensive assessment of damage, and can efficiently detect foreign bodies in the skull and cervical vertebrae. Duplex ultrasound to be a viable method to exclude macrovascular injury in unstable patients who are not eligible for computed tomography angiography (CTA) or catheter angiography imaging. Widely available duplex ultrasound and x-ray should be considered in emergency situations.
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Affiliation(s)
| | - Yi Zhao
- Department of Otorhinolaryngology
| | - Bingshan Cha
- Department of Vascular Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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17
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Penetrating Neck Trauma: a Review. CURRENT TRAUMA REPORTS 2019. [DOI: 10.1007/s40719-019-0154-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Wang Y, Sun Y, Zhou T, Liu GH, Zhang XM, Yue JX, Xiong XG, Liu BH, Yang CZ, Kong W, Wang YJ. Penetrating neck trauma caused by a rebar: A case report. Medicine (Baltimore) 2018; 97:e0468. [PMID: 29668621 PMCID: PMC5916684 DOI: 10.1097/md.0000000000010468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Penetrating neck trauma has a mortality of 3% to 6% and is associated with serious complications, mainly due to the high density of vital structures in this area and the lack of corresponding protection from bone. PATIENT CONCERNS A 55-year-old man who suffered neck trauma involving the parotid gland, caused by a rebar, after suffering a fall from the second floor of a building. DIAGNOSES Penetrating neck trauma. INTERVENTIONS The patient underwent a neck exploration under general anesthesia in the emergency operating room and tracheotomy was performed prophylactically. OUTCOMES The foreign object was ultimately removed successfully with no complications. LESSONS We concluded that computed tomography (CT) and three-dimensional reconstruction of the CT images can be a viable method to exclude macrovascular injury for patients who are in an emergency condition and are not eligible for computed tomography angiography (CTA). A chest tube could be used as an option for the removal of foreign bodies in the case of sharp or rough objects (such as spiral foreign bodies), when fully exposing the foreign body and its track.
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Affiliation(s)
- Yan Wang
- Department of Otorhinolaryngology
| | - Yu Sun
- Department of Otorhinolaryngology
| | - Tao Zhou
- Department of Otorhinolaryngology
| | - Guo-hui Liu
- Department of Orthopaedic, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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19
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Historical Case of Cervical Penetrating Wound: From First Aid to Surgical Intervention. Case Rep Otolaryngol 2017; 2017:2415679. [PMID: 29201478 PMCID: PMC5671697 DOI: 10.1155/2017/2415679] [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: 05/13/2017] [Revised: 08/27/2017] [Accepted: 09/17/2017] [Indexed: 11/18/2022] Open
Abstract
Objective We report a case of cervical penetrating wound by posing the problem of its support and by analyzing the chain of survival of a patient to human sacrifice. Case Report It was an 11-year-old boy admitted to the hosting service of cervical penetrating wound emergency occurring in a context of human sacrifice by weapon (knife). On admission, the conscious patient had a left cervical hematoma at the level of the cervical zone II and severe signs of acute anemia. The exploratory cervicotomy, carried out 12 hours after the trauma under transfusion, allowed us to highlight a section of the front edge of the sternocleidomastoid and previous jugular muscles under hyoid. We noted the presence of a linear wound of 1 cm at the level of the left internal jugular vein. The wound of the internal jugular vein has been repaired with the Prolene 4.O. The outcome was good, allowing the exit 10 days after cervicotomy. Conclusion The causal circumstances of cervical penetrating wounds are diverse. Their importance or their severity depends on the causative circumstances dominated by aggression and attempts to autolysis. Human sacrifice, with use of the weapon, is an exceptional circumstance.
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Karaolanis G, Maltezos K, Bakoyiannis C, Georgopoulos S. Contemporary Strategies in the Management of Civilian Neck Zone II Vascular Trauma. Front Surg 2017; 4:56. [PMID: 29034244 PMCID: PMC5626842 DOI: 10.3389/fsurg.2017.00056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 09/08/2017] [Indexed: 11/22/2022] Open
Abstract
Neck trauma is the leading cause of death mainly in younger persons posing to surgeons the dilemma whether to proceed with reconstruction of vascular injuries either in the presence of coma or in severe neurological deficit. Vascular injuries in zone II predominate over the other injuries located in zones I/III of the neck. Conventional open repair of carotid injuries with primary closure or interposition grafting is always recommended due to the effective long-term results for penetrating injuries or for patients unfit for endovascular intervention. In cases of blunt trauma, anticoagulation or antiplatelet therapy should be administered first in neurologically stable patients. In case of worsening of the neurological status of the patient despite adequate anticoagulation endovascular means should be considered in cases of appropriate anatomy of the arterial trauma. We provide an update on penetrating/blunt trauma in zone II of the neck, giving emphasis on the anticoagulant and endovascular treatment.
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Affiliation(s)
- Georgios Karaolanis
- First Department of Surgery, Division of Vascular Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Maltezos
- First Department of Surgery, Division of Vascular Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Chris Bakoyiannis
- First Department of Surgery, Division of Vascular Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotiris Georgopoulos
- First Department of Surgery, Division of Vascular Surgery, National and Kapodistrian University of Athens, Athens, Greece
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Lucas O, Naseem HUR, Davies JM, Reynold R, Bass KD. Endovascular treatment of a carotid artery pseudoaneurysm due to penetrating trauma in a pediatric patient. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2016.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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