Traumatic Neck Wound - Thoracic Outlet - ?? CT ??

[Bullard, Kelley MD ACMC]

I had a patient with a similar injury, a long rent down the membranous
portion of the trachea. He had large bilateral pneumothoraxes and massive
subcutaneous emphysema. Once chest tubes were in, he remained extubated and
clinically stable. We watched him for about a week. Repeat CT showed healing
of the membranous portion, he went home after ~10 days. I've seen him back
in clinic... He looks and feels great. Take home message "treat the patient
not the radiograph".

-kb

-----Original Message-----
From: KMATTOX at aol.com [mailto:KMATTOX at aol.com] 
Sent: Monday, August 07, 2006 6:41 AM
To: trauma-list at trauma.org
Subject: Traumatic Neck Wound - Thoracic Outlet - ?? CT ??


 
In a message dated 8/7/2006 8:14:42 A.M. Central Standard Time,  
drnavingoyal at yahoo.co.in writes:

Later on  CT of the neck and chest done which showed rent in the 
posterolateral aspect  of the trachea  above the carina. Surgical emphysema
in the neck  
has not increased rather slightly decreased. Patient is perfectly stable now

he has been extubated . 

Should we still do a  surgical closure of the rent in the trachea??





YES,  Contact surgery at time of admission and to OR WITHOUT  CT.    
Tracheostomy would have shown area of  injury.    Incision should be Right 
posterolateral 4th interspace  .   Divide the azygous vein to expose the
area of the 
trachea at the  carina.   Use Dexon,  I would use 4(0) size, I would NOT use

plastic suture or PDS,  I believe such is  contraindicated.    
 
I still do not understand why CT continues to be done in such  cases.   In
my 
view, except for mediastinal traverse from GSW, there  is virtually NO 
INDICATION for CT in the acute evaluation of chest  trauma.   
 
With the description given one should also be concerned for an injury to
the 
esophagus.   
 
k
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/traumalist.html