socal acs 2014 - penetrating neck trauma
DESCRIPTION
Southern California American College of Surgeons 2014: "The Utility of Anatomic “Zones” of the Neck in the Assessment of Penetrating Neck Injury"TRANSCRIPT
The Utility of Anatomic “Zones” of the Neck in the Assessment of Penetrating Neck Injury
January 17, 2014
Garren M. I. Low, MS, Kenji Inaba, MD, Konstantinos Chouliaras, MD, Bernardino Branco, MD, Lydia Lam, MD,
Elizabeth Benjamin, MD, Jay Menaker, MD, Demetrios Demetriades, MD, PhD
• No Disclosures
Financial Disclosures
• After WWII• Penetration of the platysma mandated
exploration• 40-60% negative exploration
• Starting in the 1980’s• Neck Zone approach
Background
Zone 1
Zone 2
Zone 3
• Neck zones drive management• Zone II• Zones I & III
Utility of Neck Zone Approach
• Classical imaging for zones I and III• Expensive• Time-consuming• Often negative
• Zone II• Often negative
• Ct angio• Predictive value of external wound
Problems with Zone Approach
• To characterize the association between external wounds and the corresponding internal injuries after penetrating neck trauma.• Identify clinical utility of anatomic neck
zone scheme
Objective
• Prospectively collected database• 146 patients
• LAC+USC Medical Center
• 12/2008 through 03/2011
Methods
2012
• All patients underwent structured clinical examination documenting external wound• Senior resident or attending
Methods
Penetrating Neck Injury
Hard Signs OR
Soft Signs Diagnostic Modalities
No Signs Observation• active hemorrhage• expanding or pulsatile hematoma• bruit or thrill in the area of injury• shock unresponsive to initial fluid
resuscitation• massive hemoptysis or hematemesis• air bubbling through the injury site
Penetrating Neck Injury
Hard Signs OR
Soft Signs CT Angio
No Signs Observation• venous oozing• nonexpanding or nonpulsatile
hematomas• minor hemoptysis• dysphonia, dysphagia• subcutaneous emphysema
Penetrating Neck Injury
Hard Signs OR
Soft Signs CT Angio
No Signs Observation
• “Unexpected” internal injury• Internal injury laid outside the borders
of the neck zone corresponding with the external wound
• “Expected” internal injury
Methods
• Age• Mean 31 yo
• Gender• 86% Male
• MOI• 47% GSW• 51% SW
Demographics
Hard Signs
OR
Soft Signs
Diagnostic Modalities
No Signs
Observation
• Hard signs• 32 (22%) patients• Underwent neck exploration
Hard Signs
OR
Soft Signs
CT Angio
No Signs
Observation
• Soft signs• 114 (78%) patients• CT Angio• Management based on
results
Hard Signs
OR
Soft Signs
Diagnostic Modalities
No Signs
Observation
• No signs• Observation• Min 24 hr
Zone 1- 27 patientsZone 2- 57 patientsZone 3- 32 patientsMultiple Neck Zones- 22 patients
No ExternalNeck Wound- 8 patients
• 37 patients with internal neck injury• 50 total injuries
• 44 (88%) were vascular structures• 6 (12%) were aerodigestive tract injuries
Results
• 50 internal injuries• 8 (16%) Unexpected Internal Injuries
• 42 (84%) Expected Internal Injuries
Internal Injuries
• There was a high incidence of non-correlation (16%)
• 6% were not from external neck wounds
• The utility of the anatomic zone approach is questionable.• Clinical presentation
Conclusion