2017-18 HSC Section 3 Green Book

m a d s e n e t a l c t a f o r a e r o d i g e t s i v e t r a c t i n j u r y f o l l o w i n g p e n e t r a t i n g n e c k i n j u r y

the neck. A prospective study of 59 patients. Eur J Vasc Endovasc Surg . 2004;28:425 e 430 . 10. Munera F, Sota Ja, Palacio D, et al. Diagnosis of arterial injuries caused by penetrating trauma to the neck: comparison of helical CT angiography and conventional angiography. Radiology . 2000;216:356 e 362 . 11. Munera F, Sota Ja, Palacio D, et al. Penetrating neck injuries: helical CT angiography for initial evaluation. Radiology . 2002;224:366 e 372 . 12. Gracias VH, Reilly PM, Philpott J, Klein WP, Lee SY, Singer M. Computed tomography in the evaluation of penetrating neck trauma: a preliminary study. Arch Surg . 2001;136:1231 e 1235 . 13. Ofer A, Nitecki SS, Braun J, et al. CT angiography of the carotid arteries in trauma to the neck. Eur J Vasc Endovasc Surg . 2001;21:401 e 407 . 14. Mazolewski PJ, Curry JD, Browder T, Fildes J. Computed tomographic scan can be used for surgical decision making in zone II penetrating neck injuries. J Trauma . 2001;51:315 e 319 . 15. Gonzalez RP, Falimirski M, Holevar MR, Turk B. Penetrating zone II neck injury: does dynamic computed tomographic scan contribute to the diagnostic sensitivity of physical examination for surgically significant injury? A prospective blinded study. J Trauma . 2003;54:61 e 64 . 16. Woo K, Magner DP, Wilson MT, Marquiles DR. CT angiography in penetrating neck trauma reduces the need for operative neck exploration. Am Surg . 2005;71:754 e 758 . 17. Inaba K, Munera F, McKenney M, et al. Prospective evaluation of screening multislice helical computed tomographic angiography in the initial evaluation of penetrating neck injuries. J Trauma Acute Care Surg . 2006;61:144 e 149 . 18. Inaba K, Branco BC, Menaker J, et al. Evaluation of multidetector computed tomography for penetrating neck injury: a prospective multicenter study. J Trauma Acute Care Surg . 2012;72:576 e 583 . 19. Osborn TM, Bell RB, Qaisi W, et al. Computed tomographic angiography as an aid to clinical decision making in the selective management of penetrating injuries to the neck: a reduction in the need for operative exploration. J Trauma . 2008;64:1466 e 1471 . 20. Laing GL, Bruce JL, Aldous C, Clarke DL. The design, construction and implementation of a computerized trauma registry in a developing South African metropolitan trauma service. Injury . 2014;45:3 e 8 . 21. Laing GL, Bruce JL, Skinner DL, Allorto NL, Clarke DL, Aldous C. Development, implementation, and evaluation of a hybrid electronic medical record system specifically designed for a developing world surgical service. World J Surg . 2014;38:1388 e 1397 . 22. Roon A, Christensen N. Evaluation and treatment of penetrating cervical injuries. J Trauma . 1979;19:391 e 397 . 23. American College of Surgeons Committee on Trauma. Advanced trauma Life Support ATLS for Doctors . 9th ed. Chicago: American College of Surgeons; 2012 . 24. Smakman N, Nicol AJ, Walther G, Brooks A, Navsaria PH, 25. Asensio J, Chahwan S, Forno W, et al. Penetrating esophageal injuries: multicenter study of the American Association for the Surgery of Trauma. J Trauma . 2001;50:289 e 910, 6 . 26. Asensio J, Berne J, Demetriades D, et al. Penetrating esophageal injuries: time interval of safety for preoperative evaluation d how long is safe? J Trauma . 1997;43(2):319 e 324 . Zellweger R. Factors effecting outcome in penetrating oesophageal trauma. Br J Surg . 2004;91:1513 e 1519 .

Conclusions

CTA for PNI has a high sensitivity and specificity for demon- strating vascular injury. The absence of surgical emphysema in the deep cervical fascial planes virtually excludes a surgi- cally significant ADTI. Conversely, the presence of deep sur- gical emphysema is suggestive of ADTI and/or pneumothorax, but the specificity of this finding is low. The presence of deep surgical emphysema should prompt further investigation.

Acknowledgment

M.A.S. helped in data collection drafting. O.G. carried out advice and discussion. L.G.L. did data collection and concept. B.J.L. helped in data collection referencing. C.D.L. carried out supervision of higher degree.

Disclosure

The authors reported no proprietary or commercial interest in any product mentioned or concept discussed in the article.

r e f e r e n c e s

1. Atteberry LR, Dennis JW, Menawat SS, Frykberg ER. Physical exam alone is safe and accurate for evaluation of vascular injuries in penetrating Zone II neck trauma. J Am Coll Surg . 1994;179:657 e 662 . 2. Sekharan J, Dennis JW, Veldenz HC, Mirando F, Frykberg E. Continued experience with physical examination alone for evaluation and management of penetrating zone 2 neck injuries: results of 145 cases. J Vasc Surg . 2000;32:483 e 488 . 3. Demetriades D, Charalambides D, Lakhoo M. Physical examination and selective conservative management in patients with penetrating injuries of the neck. Br J Surg . 1993;80:1534 e 1536. Conclusion: Physical examination is a reliable method for detecting significant injuries following penetrating trauma. Emergency angiography is rarely necessary. (prospective study) . 4. Demetriades D, Theodorou D, Cornwell E, et al. Evaluation of penetrating injuries of the neck: prospective study of 223 patients. World J Surg . 1997;21:41 e 47 . 5. Beitsch P, Weigelt JA, Flynn E, Easley S. Physical examination and arteriography in patients with penetrating zone II neck wounds. Arch Surg . 1994;129:577 e 581 . 6. Sclafani SJ, Cavaliere G, Atweh N, Duncan AO, Scalea T. The role of angiography in penetrating neck trauma. J Trauma . 1991;31:557 e 562 . 7. Rao PM, Ivatury RR, Sharma P, Vinzons AT, Nassoura Z, Stahl WM. Cervical vascular injuries: a trauma center experience. Surgery . 1993;114:527 e 531 . 8. Klyachkin ML, Rohmiller M, Charash WE, Sloan DA, Kearney PA. Penetrating injuries of the neck: selective management evolving. Am Surg . 1997;63:189 e 194 . 9. Mohammed GS, Pillay WR, Barker P, Robbs JV. The role of clinical examination in excluding vascular injury in haemodynamically stable patients with gunshot wounds to

54