STAB INJURIES OF THE NECK- A NIGHTMARE FOR SURGEONS

AshokSwaminathan Govindarajan, Shabnam Fathima, Subramanian. C.S, Sivaraj A
2016 International Journal of Advanced Research  
The management of penetrating neck trauma has always been a nightmare for surgeons. The platysma is the peritoneum of the neck. Though the dimension of the injury may appear trivial, it may be masking a life threatening injury. The vital structures are closely packed in the neck especially in zone 2 and they are at risk in penetrating neck injuries. These vital structures are primarily the airway, vascular structures, esophagus, spinal column including the spinal cord, the lower cranial nerves,
more » ... the brachial plexus and the thoracic duct on the left neck 1 . Patients with uncontrollable hemorrhage, expanding hematomas or those in shock need immediate hemorrhage control. It means transfer of the patient to the operating room and exploration under good light and adequate anesthesia. Here we report a case of "soda bottle injury" of left side of neck. Clinical profile:- A 32 year old gentleman was brought in state of shock with an active bleeding following assault by unknown persons with soda bottle injury (stab injury)over the left side of neck half an hour back. Patient was conscious and his blood-pressure was 70/? with a pulse rate of 120 per minute and feeble with no breathing difficulty. There was profuse bleeding from wound. As per ATLS protocol primary survey was carried out for ABC's airway, breathing and circulation. On examination an irregular laceration 4 x 2 cm over the anterior triangle of left side of neck at about 3 cms lateral to hyoid bone over vascular zone 2 just in front of medial border of left sternocleidomastoid muscle . After initial and immediate resuscitative measures, with adequate blood he was shifted to operating room. After stabilizing and under general anesthesia, the laceration was explored. A partial transection injury of the left internal jugular vein identified and was ligated under loupe magnification. There were also few glass pieces in the neck wound which were removed carefully. The wound was closed with a drain in layers. But immediately after dressing the wound, the drain was filling rapidly and the wound dressing was soaked. The blood pressure and pulse was not picking up even after ligation of internal jugular vein. Immediately we planned to re explore the wound under same anesthesia. We were surprised to see another small rent of 0.5 x 0.5 cm in the internal jugular vein proximal to the previous injury. It was repaired under loupe magnification with 7-0 prolene interrupted.
doi:10.21474/ijar01/1913 fatcat:db4237n4znhrnno6h6k55nmvmy