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Hard signs neck trauma4/7/2024 ![]() Also during the time that technology had been advancing, many reports have documented the safety of selective management of neck injuries that penetrate the platysma. This fact, along with advances in technology, such as high resolution computed tomography (CT), may eliminate the need to explore the neck to determine whether there are injuries. Mandatory exploration, while seemingly safe and conservative, led to many nontherapeutic operations. The management of these patients has been evolving from an era of mandatory exploration to an era of more selective management. ![]() Controversy arises over management of the patient without significant symptoms. For the patients with hard signs of significant injury, including active hemorrhage, expanding hematoma, bruit, pulse deficit, subcutaneous emphysema, hoarseness, stridor, respiratory distress, or hemiparesis, immediate operative management may be indicated. Appropriate and timely management of these injuries is critical. Delayed complications such as pseudoaneurysms or arteriovenous fistulae can affect long-term outcomes. Mortality, particularly for major vascular injuries may reach 50%. Because of the density of vital structures in this zone, multiple injuries are common and can affect length of stay. ![]() Zone II, between zones I and III, is the area of controversy. Zone III, above the angle of the mandible, is treated as a head injury. Zone I, including the thoracic inlet, up to the level of the cricothyroid membrane, is treated as an upper thoracic injury. The neck has been divided into threes zones. The management of injuries to the neck that penetrate the platysma is dependent on the anatomic level of injury. For gunshot wounds, approximately 50% (higher with high velocity weapons) of victims have significant injuries, whereas this risk may be only 10% to 20% with stab wounds. Risk of significant injury to vital structures in the neck is dependent on the penetrating object. Penetrating wounds of the neck are common in the civilian trauma population. Tisherman, MD, Department of Critical Care Medicine, 638 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261 email: Statement of the Problem MD Bokhari, Faran MD Collier, Bryan DO Cumming, John MD Ebert, James MD Holevar, Michele MD Kurek, Stanley DO Leon, Stuart MD Rhee, Peter MD Author Informationįrom the Departments of Surgery and Critical Care Medicine (S.A.T.), University of Pittsburgh, Pittsburgh, Pennsylvania Department of Trauma (F.B.), Stroger Hospital of Cook County, Chicago, Illinois Department of Surgery (B.C.), Vanderbilt University, Nashville, Tennessee Department of Emergency Medicine (J.E.), Elmhurst Memorial Healthcare, Elmhurst, Illinois Department of Surgery (M.H.), Mount Sinai Hospital, Chicago, Illinois Department of Surgery (J.C.), Stamford Hospital, Stamford, Connecticut Department of Surgery (S.K.), University of Tennessee Medical Center at Knoxville, Knoxville, Tennessee Department of Surgery (S.L.), Medical University of Southern Carolina, Charleston, South Carolina and Department of Surgery (P.R.), University of Arizona, University Medical Center, Tucson, Arizona.Īccepted for publication December 18, 2007.Īddress for reprints: Samuel A. Exempt Purpose, Mission, Vision & Goals.Interviews with Research Scholarship & Award Recipients. ![]() Equity, Diversity, and Inclusion in Trauma Surgery Practice.Landmark Papers in Trauma and Acute Care Surgery.
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