Transcervical gunshot injuries.
Gunshot injuries across the cervical midline are not addressed in existing trauma algorithms. A retrospective study of 41 patients with transcervical gunshot wounds was undertaken to delineate injury patterns and management principles. Thirty-four of the 41 patients (83%) sustained 52 injuries to major cervical structures. Vascular (22 injuries) and upper airway (13 injuries) structures were most commonly involved. This resulted in presentation with life-threatening problems in 16 patients (39%). The in-hospital mortality was 10%. In 30 of the 36 neck explorations (83%), the findings were positive for injuries to cervical structures. Sixteen bilateral explorations were performed; in each case, cervical injury was observed on at least one side of the neck. These results indicate that transcervical injuries are excellent markers of associated visceral injury. Therefore, a policy of mandatory neck exploration and a particularly "low threshold" for bilateral exploration are the key to managing these injuries.
Hirshberg
A
A
Cora and Webb Mading Department of Surgery, Baylor College of Medicine, Houston, Texas 77030.
Wall
M J
MJ
Johnston
R H
RH
Burch
J M
JM
Mattox
K L
KL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000402:Airway Obstruction / Q000209:etiology; D001808:Blood Vessels / Q000293:injuries; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000098:blood supply / Q000601:surgery; D019838:Neck Injuries; D012189:Retrospective Studies; D014948:Wounds, Gunshot / Q000150:complications / Q000401:mortality / Q000601:surgery*