Penetrating Injuries to the Neck: Operation, Observation or Angiointervention
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.
KeywordsVascular Injury Subcutaneous Emphysema Stab Wound Significant Injury Orotracheal Intubation
Unable to display preview. Download preview PDF.
- 2.Demetriades D, Theodorou D, Cornwell E et al (1995) Transcervical gunshot injuries: mandatory operation is not necessary. J Trauma 40:758–760Google 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. 415–418Google Scholar
- 12.Demetriades D (2003) Neck Injury, in Color Atlas of Emergency Trauma, eds. Mondavia, Newton, Demetriades. Cambridge University Press, Cambridge pp. 59–81Google 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 899:644–646Google Scholar
- 37.Demetriades D, Velmahos G, Asensio J (2001) Cervical pharyngoesophageal and laryngotracheal injuries. World J Surg 1044–1048Google 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. 330–337Google Scholar
- 43.Shenk WG (1992) Neck Injuries: In: Principles of Trauma Surgery. Moylan JA (ed) New York, Gower, pp. 1550–1565Google Scholar