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Chirurgie 1. Dezember 2011

Vascular surgery for penetrating injury of the neck*

BACKGROUND: Vascular injuries due to penetrating neck trauma are rare, but potentially lethal injuries. METHODS: 17 patients were treated for vascular injuries after penetrating neck trauma by specialised vascular surgeons between 1.1.1998 and 31.12.2010. All patients underwent surgical exploration and vascular surgical treatment for bleeding. RESULTS: Trauma mechanism was stab wound in 9 patients, metal fragments in 3 and various items in 5 patients. 4 patients had attempted suicide, and 3 patients were injured in a fight or murder attempt. The injuries were to zone II according to Monson in 14 patients, zone I in 2 patients, and zones I and II in 1 patient. In 8 patients arterial injuries and in 9 patients venous lesions were treated. Mortality was 11.8% (2/17 patients). CONCLUSIONS: Penetrating trauma to the neck is a serious and potentially lethal injury. CTA is recommended in the literature in diagnostic exploration of hemodynamically stable patients. Emergency surgery by an experienced vascular surgeon can help to determine the extent of trauma and its treatment. In arterial trauma to the carotid arteries a complete intraoperative exposure with external and internal inspection of the vessel including the intimal layer is recommended. The role of endovascular treatment for vascular injury due to penetrating neck trauma needs further evaluation.

T. U. Cohnert, S. Koter, S. Schweiger, J. Fruhmann, P. Konstantiniuk, A. Baumann, European Surgery 6/2011

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