Evaluation of the use of tomography in penetrating neck trauma

Nasr, Adonis; Oliveira, Jéssica Tamara De; Mazepa, Melissa Mello; Albuquerque, Christine Lima Cavalcanti De; Martini, Gabriela Soraya; Nazario, Mariana; Carvalho, Fábio Henrique de

doi:10.1590/0100-69912015004004

Cited by 15 publications

(26 citation statements)

References 23 publications

(25 reference statements)

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“…Given the current rise of MDCT-A use in PNIs, it's genuine that most high-volume trauma centres recommend its routine use in their recent management protocols. 7,8,13 In our study, MDCT-A carried specificity of 97%, sensitivity of 77%, positive predictive value of 93% and negative predictive value of 89% in detection of injuries. These results are comparable to many published studies.…”

Section: Discussionsupporting

confidence: 49%

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A tailored protocol in management of penetrating neck injuries: experience at a level 1 trauma centre

2021

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Background: The management of penetrating neck injuries (PNIs) evolved markedly over last year’s towards more conservative approaches. Recent improvements in imaging modalities as multi-detector CT-angiography (MDCT-A) produced a paradigmatic shift towards 'no-zone' approach. In this study, we adopted a tailored protocol to deal with such injuries with less dependency on zone classification.Methods: This prospective study included patients with PNIs from February 2012 to January 2014. Unstable patients and patients with hard signs in zone-II were managed by immediate exploration. Patients with hard signs in zones-I and III had MDCT-A to check feasibility of endovascular intervention. However, all patients with soft signs and asymptomatic patients underwent MDCT-A regardless the zone affected to determine the need for therapeutic intervention. Complementary investigations were added in some cases with equivocal MDCT-A results.Results: Our study included 85 patients. Majority were males (94%; n=80) with mean age 27±4. Stabs were the main causative injury (51%; n=43). 63 (74%) patients were stable; with majority (64%; n=40/63) were symptomatic (18 presented with hard signs and 22 presented with soft signs). 53 (62%) patients had MDCT-A with sensitivity, specificity of 77%, 97% respectively and significant p value <0.05. After applying this protocol, we avoided 37% (31/85) non-therapeutic neck exploration, with only 4 (7.4%) negative cases on exploration. We experienced no missed injuries in the conservative group, yet 2 (3.7%) missed nerve injuries were encountered in intervention group.Conclusions: Zones-classification is losing popularity nowadays and shouldn't be the cornerstone of the new management protocols in PNIs. This selective tailored approach can be effectively used in management of PNIs. It avoids missed injuries and unnecessary explorations significantly.

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Section: Discussionsupporting

confidence: 49%

“…However, the number of published protocols which rely on MDCT-A are still scare. 4,[8][9][10][11] In our institution, we have a high flow of trauma cases (nearly 9,000-12,000 cases/year). PNIs represent about 0.1-0.4% of all trauma cases (nearly 40-50 cases/year).…”

mentioning

confidence: 99%

A tailored protocol in management of penetrating neck injuries: experience at a level 1 trauma centre

2021

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“…Las lesiones penetrantes del cuello representan alrededor del 5-10% de todos los casos de trauma que se presentan en el Servicio de Urgencias y dan como resultado una mortalidad significativa. [1][2][3] Los componentes cervicales con más frecuencia lesionados en traumatismos penetrantes están relacionados con las lesiones vasculares (21-27%), seguido de la médula espinal (16%) y el tracto aero-digestivo (6-10%), como la laringe o la tráquea y de la faringe o el esófago. 1 Lo más común es que estas lesiones sean secundarias a heridas por arma blanca y de fuego.…”

Section: Antecedentesunclassified

Herida por proyectil de arma de fuego en cuello con lesión traqueoesofágica y colocación de parche muscular de esternotiroideo

Palacios-Zertuche

Montero-Cantú

Guerrero-Hernández

et al. 2016

NCT Neumología Y Cirugía De Tórax

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Este artículo puede ser consultado en versión completa en http://www.medigraphic.com/neumologia RESUMEN. Antecedentes: Las lesiones penetrantes del cuello representan del 5-10% de todos los casos de trauma que se presentan en el Servicio de Urgencias y dan como resultado una mortalidad signifi cativa. Caso clínico: Masculino de 34 años de edad que acudió al Departamento de Urgencias por presentar herida por proyectil de arma de fuego en cuello. Se le realizó intubación endotraqueal y trasladado a quirófano. Por medio de una incisión cervical transversa se observaron lesión esofágica y traqueal a nivel del tercero y cuarto anillo, se colocó cánula de traqueostomía en orifi cio anterior de lesión traqueal, desbridando bordes de lesiones esofágicas y cerrando de forma primaria. Se tomó un colgajo vascularizado de esternotiroideo para colocar parche muscular entre la lesión traqueal y esofágica, dejando drenaje y realizando gastrostomía. Al paciente se le dio alimentación enteral por la gastrostomía, al décimo día se inició vía oral sin datos de fuga. Conclusión: Es imprescindible colocar un colgajo de músculo vascularizado de esternocleidomastoideo o un músculo infrahioideo para proteger la reparación esofágica y reducir la incidencia de fuga y fístula traqueoesofágica. Palabras clave: Lesiones en cuello, lesiones traqueales, lesiones esofágicas, parche muscular. ABSTRACT. Background: Penetrating neck injuries represent 5-10% of all trauma lesions that present to the emergency room resulting in signifi cant mortality. Case report: 34-year-old male is brought to the emergency room with a gunshot wound in the neck. Urgent endotracheal intubation was performed and then referred to the operating room. We performed a transverse cervical incision observing both, esophageal and tracheal lesions comprising the third and fourth tracheal rings. A tracheostomy tube was put in place through the anterior tracheal lesion. Debridement of the borders and primary closure of the esophageal lesion was carried out in order to place a vascularized sternothyroid muscle fl ap between the tracheal and esophageal injuries. A drain is placed and gastrostomy is performed. Enteral nutrition via gastrostomy was indicated for ten days. Oral intake was reinstituted afterwards without evidence of leakage. Conclusion: A vascularized muscle fl ap, involving the sternocleidomastoid or infrahyoid muscles, is critical to protect the esophageal repair and reduce the incidence of tracheoesophageal fi stulas and leakage.

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“…These refer to neck injuries resulting from injuries by firearms, stabbing or penetrating fragments, such as glass or shrapnel, which go beyond the platysma muscle. PCT's can cause damage to the respiratory, digestive and neurovascular systems (Chapman et al, 2020).Mandatory surgical exploration of PCTs remained widely accepted until the 1990s, when it was realized that, despite the best results, mandatory surgery had unacceptably high negative rates of exploration -approximately 58% of the patients approached did not have serious injuries (Nasr et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Medical Approach in Penetrant Cervical Trauma: An Educational View

Zambrana¹,

Kairala²,

Etrusco³

et al. 2020

JEHD

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Doubts about procedures are common within the medical field, especially within the area of surgical clinic or medical surgery. In view of this explanation, the present was limited to carrying out a literary review on the subject of penetrating cervical trauma. To this end, research was carried out in databases linked to health and medicine, with specific descriptors for the subject, and articles from the years 2000 to 2020 were selected to clarify the subject. Penetrating cervical traumas are injuries to the neck that go beyond the platysma muscle. There is currently a great debate about the conduct to be adopted in such injuries. Penetrating cervical trauma comprises 5% to 10% of traumatic injuries in adults. In the last decade, mortality from penetrating cervical trauma was approximately 5%. The initial approach in the emergency room should be systematized in order to quickly identify possible signs of severity that usually require the immediate transfer of the patient to the operating room. Clinical examinations should be performed in order to elucidate and direct the surgeon to the best treatment for the patient. Finally, it is possible to conclude that cervical injuries are better treated with selective management.

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Evaluation of the use of tomography in penetrating neck trauma

Cited by 15 publications

References 23 publications

A tailored protocol in management of penetrating neck injuries: experience at a level 1 trauma centre

A tailored protocol in management of penetrating neck injuries: experience at a level 1 trauma centre

Herida por proyectil de arma de fuego en cuello con lesión traqueoesofágica y colocación de parche muscular de esternotiroideo

Medical Approach in Penetrant Cervical Trauma: An Educational View

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