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SoCal ACS 2014 - Penetrating Neck Trauma
- 1. The Utility of Anatomic “Zones” of the Neck in the Assessment of Penetrating Neck Injury 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 January 17, 2014
- 2. Financial Disclosures • No Disclosures
- 3. Background • After WWII • Penetration of the platysma mandated exploration • 40-60% negative exploration • Starting in the 1980’s • Neck Zone approach
- 4. Zone 3 Zone 2 Zone 1
- 5. Utility of Neck Zone Approach • Neck zones drive management • Zone II • Zones I & III
- 6. Problems with 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
- 7. Objective • To characterize the association between external wounds and the corresponding internal injuries after penetrating neck trauma. • Identify clinical utility of anatomic neck zone scheme
- 8. Methods • Prospectively collected database • 146 patients • LAC+USC Medical Center • 12/2008 through 03/2011 2012
- 9. Methods • All patients underwent structured clinical examination documenting external wound • Senior resident or attending
- 10. Hard Signs Penetrating Neck Injury • • • • • • OR Soft Signs Diagnostic Modalities Observation active hemorrhage No Signs 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
- 11. Hard Signs Penetrating Neck Injury • • • • • OR Soft Signs CT Angio Observation venous oozing No Signs nonexpanding or nonpulsatile hematomas minor hemoptysis dysphonia, dysphagia subcutaneous emphysema
- 12. Hard Signs Penetrating Neck Injury OR Soft Signs CT Angio No Signs Observation
- 13. Methods • “Unexpected” internal injury • Internal injury laid outside the borders of the neck zone corresponding with the external wound • “Expected” internal injury
- 14. Demographics • Age • Mean 31 yo • Gender • 86% Male • MOI • 47% GSW • 51% SW
- 15. Hard Signs Soft Signs Diagnostic Modalities No Signs Penetrating Neck Injury OR Observation • Hard signs • 32 (22%) patients • Underwent neck exploration
- 16. Hard Signs Soft Signs CT Angio No Signs Penetrating Neck Injury OR Observation • Soft signs • 114 (78%) patients • CT Angio • Management based on results
- 17. Hard Signs Soft Signs Diagnostic Modalities No Signs Penetrating Neck Injury OR Observation • No signs • Observation • Min 24 hr
- 18. No External Neck 3 Wound Multiple Zone 1 Neck Zones 2 8 patients - 22 patients 32 27 57
- 19. Results • 37 patients with internal neck injury • 50 total injuries • 44 (88%) were vascular structures • 6 (12%) were aerodigestive tract injuries
- 20. Internal Injuries • 50 internal injuries • 8 (16%) Unexpected Internal Injuries • 42 (84%) Expected Internal Injuries
- 21. Conclusion • 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
Editor's Notes
- Chicago paper (Cook county?)
- Because of the easy surgical access zone 2Because of difficult access Zone 1,3
- World’s largest CT angio study 2012
- Replace with picture
- Instead of using the zones, hard signs etc. approach to neck injury is better