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Penetrating Injuries to the Neck: Operation, Observation or Angiointervention

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Anaesthesia, Pain, Intensive Care and Emergency A.P.I.C.E.

Abstract

Penetrating neck injuries (PNI) are notoriously difficult to evaluate and manage because of the complex anatomy and the dense concentration of numerous vital structures in a small anatomical area. The clinical evaluation can challenge the skills of the less experienced physicians and significant injuries may easily be missed. The radiological evaluation of these injuries has undergone major changes in the last fewyears and shifted from invasive diagnostic procedures to noninvasive methods, but the selection of the most appropriate investigation remains a controversial issue. New advances in interventional radiology have revolutionized the management of some complex vascular injuries. The concept of selective nonoperative management in selected patients has gained considerable acceptance. This chapter discusses these issues in detail and provides practical guidelines and algorithms for the safe evaluation and initial management of PNI.

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References

  1. Demetriades D, Theodorou D, Cornwell EE et al (1997) Evaluation of penetrating injuries of the neck: Prospective study of 223 patients. World J Surg 21:41–48

    Article  PubMed  CAS  Google Scholar 

  2. Demetriades D, Theodorou D, Cornwell E et al (1995) Transcervical gunshot injuries: mandatory operation is not necessary. J Trauma 40:758–760

    Google Scholar 

  3. Danic D, Prgomet D, Miliac D et al (1998) War injuries to the head and neck. Mil Med 163:117–119

    PubMed  CAS  Google Scholar 

  4. Demetriades D, Charalambides D, Lakhoo M (1993) Physical examination and selective conservative management in patients with penetrating injuries of the neck. Br J Surg 80:1534–1536

    Article  PubMed  CAS  Google Scholar 

  5. Pate JW (1989) Tracheobronchial and esophageal injuries. Surg Clin North Am 69:111–123

    PubMed  CAS  Google Scholar 

  6. Demetriades D, Asensio JA, Velmahos GC, Thal E (1996) Complex problems in penetrating neck trauma. Surg Clin North Am 76:661–683

    Article  PubMed  CAS  Google Scholar 

  7. Mandavia DP, Quails S, Rokos I (2000) Emergency airway management in penetrating neck injury. Ann Emerg Med 35:221–225

    Article  PubMed  CAS  Google Scholar 

  8. Vassiliu P, Baker J, Henderson S et al (2001) Aerodigestive injuries of the neck. Am Surg 67:75–79

    PubMed  CAS  Google Scholar 

  9. Capan LM, Miller SM, Turndorf H (1991) Management of neck injuries. In: Capan, Miller, Turndorf (eds) Trauma Anesthesia and Intensive Care. Philadelphia JB, Lippincott pp. 415–418

    Google Scholar 

  10. Shearer VE, Giesecke AH (1993) Airway management for patients with penetrating neck trauma: a retrospective study. Anesth Analg 77:1135–1138

    Article  PubMed  CAS  Google Scholar 

  11. Gilroy D, Lakhoo M, Charalambides D, Demetriades D (1992) Control of life-threatening hemorrhage from the neck: a new indication for balloon tamponade. Injury 23:557–559

    Article  PubMed  CAS  Google Scholar 

  12. Demetriades D (2003) Neck Injury, in Color Atlas of Emergency Trauma, eds. Mondavia, Newton, Demetriades. Cambridge University Press, Cambridge pp. 59–81

    Google Scholar 

  13. Demetriades D, Rabinowitz B, Sofianos C (1987) Emergency room thoracotomy for stab wounds to the chest and neck. J Trauma 27:483–485

    PubMed  CAS  Google Scholar 

  14. Sclafani SJ, Cavaliere G, Atnweh et al (1991) The role of angiography in penetrating neck trauma. J Trauma 31:557–562

    PubMed  CAS  Google Scholar 

  15. Sclafani SJ, Cavaliere G, Atweh N et al (1991) The role of angiography in penetrating neck trauma. J Trauma 31:557–562

    PubMed  CAS  Google Scholar 

  16. Hiatt JR, Busuttil RW, Wilson SE (1984) Impact of routine arteriography on management of penetrating neck injuries. J Vasc Surg 1:860–866

    Article  PubMed  CAS  Google Scholar 

  17. Weigelt JA, Thal ER, Snyder WH et al (1987) Diagnosis of penetrating cervical esophageal injuries. Am J Surg 154:619–622

    Article  PubMed  CAS  Google Scholar 

  18. Beitsch P, Weigelt JA, Flynn E, Easley S (1994) Physical examination and arteriography in patients with penetrating zone II neck wounds. Arch Surg 129:577–581

    PubMed  CAS  Google Scholar 

  19. Eddy VA (2000) Is routine arteriography mandatory for penetrating injury to zone I of the neck? Zone I Penetrating Neck Injury Study Group. J Trauma 48:208–213

    PubMed  CAS  Google Scholar 

  20. Demetriades D, Theodorou D, Cornwell EE et al (1995) Penetrating injuries of the neck in patients in stable condition. Physical examination, angiography, or color flow Doppler imaging. Arch Surg 130:971–975

    PubMed  CAS  Google Scholar 

  21. Stain S, Yellin A, Weaver F, Pentecost M (1989) Selective management of nonocclusive arterial injuries. Arch Surg 124:1136–1140

    PubMed  CAS  Google Scholar 

  22. Frykberg ER, Crump JM, Vines FS et al (1989) A reassessment of the role of arteriography in penetrating proximity trauma: a prospective study. J Trauma 29:1041–1050

    PubMed  CAS  Google Scholar 

  23. Rao PM, Ivatury RR, Sharma P et al (1993) Cervical vascular injury: A trauma center experience. Surgery 114:527–531

    PubMed  CAS  Google Scholar 

  24. Fry WR, Dort JA, Smith RS et al (1994) Duplex scanning replaces arteriography and operative exploration in the diagnosis of potential cervical vascular injury. Am J Surg 168:693–696

    Article  PubMed  CAS  Google Scholar 

  25. Corr P, Abdoel CA, Robbs J (1999) Colour-flow ultrasound in the detection of penetrating vascular injuries of the neck. S Afr Med J 899:644–646

    Google Scholar 

  26. Montalvo BM, Leblang SD, Nunez DB et al (1996) Color Doppier sonography in penetrating injuries of the neck. AJNR 17:943–951

    PubMed  CAS  Google Scholar 

  27. Ginzburg E, Montalvo B, Leblang S et al (1996) The use of duplex ultrasonography in penetrating neck trauma. Arch Surg 131:691–693

    PubMed  CAS  Google Scholar 

  28. Kuzniec S, Kauffman P, Molnar LJ et al (1998) Diagnosis of limbs and neck arterial trauma using duplex ultrasonography. Cardiovasc Surg 6:358–366

    Article  PubMed  CAS  Google Scholar 

  29. Gracias V, Reilly P, Philpott J et al (2001) Computed tomography in the evaluation of penetrating neck trauma: a preliminary study. Arch Surg 136:1231–1235

    Article  PubMed  CAS  Google Scholar 

  30. Munera F, Soto JA, Palacio D et al (2000) Diagnosis of arterial injuries caused by penetrating trauma to the neck: comparison of helical CT angiography and conventional angiography. Radiology 216:356–362

    PubMed  CAS  Google Scholar 

  31. Munera F, Soto JA, Palacio DM et al (2002) Penetrating neck injuries: helical CT angiography for initial evaluation. Radiology 224:366–372

    Article  PubMed  Google Scholar 

  32. Nunez DB, Torres-Leon M, Munera F (2004) Vascular injuries of the neck and thoracic inlet: helical CT-angiographic correlation. Radiographic 24:1087–1098

    Article  Google Scholar 

  33. Armstrong WB, Detar TR, Standley RB (1994) Diagnosis and management of external penetrating cervical esophageal injuries. Ann Otol Rhinol Laryngol 103:863–871

    PubMed  CAS  Google Scholar 

  34. Fan ST, Lau WY, Yip WC et al (1988) Limitations and dangers of gastrografin swallow after esophageal and upper gastric operations. Am J Surg 153:495–497

    Article  Google Scholar 

  35. Srinivasan R, Haywood T, Horwitz B et al (2000) Role of flexible endoscopy in the evaluation of possible esophageal trauma after penetrating injuries. Am J Gastroenterol 95:1725–1729

    Article  PubMed  CAS  Google Scholar 

  36. Flowers JL, Graham SM, Ugarte MA et al (1996) Flexible endoscopy for the diagnosis of esophageal trauma. J Trauma 40:261–265

    Article  PubMed  CAS  Google Scholar 

  37. Demetriades D, Velmahos G, Asensio J (2001) Cervical pharyngoesophageal and laryngotracheal injuries. World J Surg 1044–1048

    Google Scholar 

  38. Meyer JP, Barret JA, Schuler JJ, Flanigan P (1987) Mandatory vs. selective exploration for penetrating neck trauma. Arch Surg 122:592–597

    PubMed  CAS  Google Scholar 

  39. Apffelstaedt JP, Muller R (1999) Results of mandatory exploration for penetrating neck trauma. World J. Surg 18:917–920

    Article  Google Scholar 

  40. Azuaje R, Jacobson LE, Glover J et al (2003) Reliability of physical examination as a predictor of vascular injury after penetrating neck trauma, Am Surg 69:804–807

    PubMed  Google Scholar 

  41. Demetriades D, Velmahos GC, Asensio JA (2000) Penetrating injuries of the neck. In “Textbook of Critical Care” (Ed. Shoemaker) 4th Edition. WB Saunders, Chapter 29, pp. 330–337

    Google Scholar 

  42. Sekharan J, Dennis JW, Veldenz HC et al (2000) Continued experience with physical examination alone for evaluation and management of penetrating zone 2 neck injuries: results of 145 cases. J Vasc. Surg 32:483–489

    Article  PubMed  CAS  Google Scholar 

  43. Shenk WG (1992) Neck Injuries: In: Principles of Trauma Surgery. Moylan JA (ed) New York, Gower, pp. 1550–1565

    Google Scholar 

  44. Ordog GJ, Albin D, Wasserberger J et al (1985) 110 bullet wounds to the neck. J. Trauma 125:238–246

    Article  Google Scholar 

  45. Van As AB, Van Durzen DF, Verleisdonk EJ (2002) Gunshots to the neck: selective angiograpy as part of conservative management. Injury 33:453–456

    Article  PubMed  Google Scholar 

  46. Hirshberg A, Wall M, Johnston R et al (1994) Transcervical gunshot injuries. Am J Surg 167:309–312

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Trauma and Surgical Critical Care, Department of Surgery, University of Southern California, Los Angeles, USA

    J. DuBose & D. Demetriades

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  1. J. DuBose
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  2. D. Demetriades
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Editors and Affiliations

  1. Department of Anaesthesia and Intensive Care Head, Postgraduated School of Anaesthesia and Intensive Care, Catania University Hospital, Catania, Italy

    Antonino Gullo M.D. (Head) (Head)

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DuBose, J., Demetriades, D. (2008). Penetrating Injuries to the Neck: Operation, Observation or Angiointervention. In: Gullo, A. (eds) Anaesthesia, Pain, Intensive Care and Emergency A.P.I.C.E.. Springer, Milano. https://doi.org/10.1007/978-88-470-0773-4_11

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  • DOI: https://doi.org/10.1007/978-88-470-0773-4_11

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-0772-7

  • Online ISBN: 978-88-470-0773-4

  • eBook Packages: MedicineMedicine (R0)

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