Penetrating neck injury: Collaterals for another life after ligation of common carotid artery and subclavian artery

Abstract

Neck, being not protected by skeleton, is vulnerable to external trauma and injury which involves blood vessels, trachea, esophagus and other endocrine and nervous system organs. Vascular injuries can not only cause potentially life-threatening hemorrhage but also need profound surgical expertise in management. Development of collateral circulation in neck is well known; however, there is scarcity of literature on the role of collateral formation in neck trauma. Here, we present a unique case of penetrating gunshot injury to neck with right common carotid and right subclavian artery injury with hemorrhagic shock managed with ligation of these vessels as a life-saving procedure. The patient presented with no neurological or motor deficits in immediate postoperative period owing to the collateral circulation between right vertebral artery and right common carotid and right subclavian artery.

Penetrating neck injuries: a guide to evaluation and management

“…7 Vascular injury may include partial or complete occlusion (most common), dissection, pseudoaneurysm, extravasation of blood or arteriovenous fistula formation. 8 Arterial injury occurs in approximately 25% of penetrating neck injuries; carotid artery involvement is seen in approximately 80% and vertebral artery in 43%. 2 Combined carotid and vertebral artery injury carry both major haemorrhagic and neurological concern.…”

“…2 Combined carotid and vertebral artery injury carry both major haemorrhagic and neurological concern. 8 Aerodigestive injury occurs in 23-30% of patients with penetrating neck injuries and is associated with a high mortality rate. 6 Pharyngo-oesophageal injuries are less common than laryngotracheal injuries but both are associated with a mortality rate of approximately 20%.…”

Clinical Evaluation of the Pattern of Different Types of Neck Injuries in Cases Undergone Autopsy

“…Extracranial arterial injuries to the brachiocephalic, common carotid, and vertebral arteries can result in major neurologic deficits. [10] Airway occlusion and exsanguinating hemorrhage pose the most immediate risks to life. From the time when Ambroise Pare successfully treated a neck injury in 1552, debate has continued about the best approach for particular neck wounds.…”

“…Except for individual nerves to specific muscles, few vital structures cross the posterior triangle, which is delineated by the sternocleidomastoid, the trapezius, and the clavicle (with the exception of the region just superior to the clavicle). [10][11] It is learnt from literature that neck injuries are encountered with different manner (suicide, homicide, accident). Sometimes homicidal neck injuries are pleaded or disguised as suicide e.g.…”

Emergency Airway Management in Neck Trauma

“…Neck injury may result in the laceration of major vessels, potentially leading to hemorrhagic shock. Extracranial arterial injuries to the brachiocephalic, common carotid, and vertebral arteries can result in major neurologic deficits [2] . Airway occlusion and exsanguinating hemorrhage pose the most immediate risks to life.…”