Validity of no-zone approach for management of isolated penetrating neck injuries in hemodynamically stable patients

Background: Routine neck exploration for isolated penetrating neck injuries (PNIs) in hemodynamically stable patients increases the frequency of unnecessary interventions and complications. Current management protocol involves the no zone approach which uses physical examination and computerized tomographic angiography (CTA) to guide treatment. The aim was to assess the validity of the no-zone approach in the management of isolated PNIs in hemodynamically stable patients.Methods: This retrospective study included patients with isolated PNIs with soft signs who were hemodynamically stable. They were classified into patients with negative CTA findings and were managed conservatively and patients with positive CTA findings suspecting aerodigestive tract injuries (ADTIs) who were submitted to further selective investigations to confirm or rule out these injuries. Detected injuries were managed accordingly.Results: This study included 106 PNIs patients who had soft signs and were hemodynamic stable. 37 cases (34.9%) had negative CTA findings and were managed conservatively. Sixty nine patients (65.1%) had positive CTA findings and were subjected to subsequent selective investigations and revealed 3 patients with negative endoscopic findings who passed without need for any surgical intervention. Therefore, 40 (37.7%) patients were saved from surgery with no missed injuries. Patients with definitive injuries (66 patients) underwent neck exploration and managed accordingly. No missed injuries were recorded in this study. Complications were detected in 6 cases (5.7%) while death was recorded in 2 cases (1.9%).Conclusions: No-zone approach offers a safe management protocol for isolated PNIs in hemodynamically stable patients. It provides no missed injuries, negligible rates of negative exploration and minimal complications and mortality.

Download Full-text

Effectiveness of No-Zone Approach for Management of Isolated Penetrating Neck Injuries Among Hemodynamically Stable Patients. A Longitudinal Retrospective Study.

10.21203/rs.3.rs-23041/v1 ◽

2020 ◽

Author(s):

Ahmed Gaber Hassanein ◽

Mohammed Hazem Elmoshneb ◽

Wael A. Ahmad ◽

Ahmed Abdel Kahaar Aldardeer ◽

Osama A. Ismail

Keyword(s):

Nerve Repair ◽

Vascular Complications ◽

Neurological Complications ◽

Neck Injuries ◽

Standard Management ◽

Management Protocol ◽

Treatment Plans ◽

Tomographic Angiography ◽

Traditional Approaches ◽

No Zone Approach

Abstract Background: Routine neck exploration for isolated penetrating neck injuries (PNIs) in hemodynamically stable patients increases the frequency of nontherapeutic surgeries, and complications. Current management protocol involves the no zone approach which uses physical examination and computerized tomographic angiography to guide treatment plans. This work aimed to study the effectiveness and reliability of no-zone approach for management of isolated PNIs in hemodynamically stable patients. Methods: cases of isolated PNIs in hemodynamically stable patients were managed using no zone approach. Detected injuries were managed accordingly. Results: This study included 106 patients. 34.9% of patients were managed conservatively while surgery was done at 65.09%. Vascular management was done in 40.57%, laryngotracheal repair in 29.2%, tracheostomy in 17%, pharyngeal repair in 7.55%, esophageal repair in 6.6%, and accessory nerve repair in 2.83%. Complications occurred in 16.04% of cases in the form of vascular complications (7.5%), respiratory complications (5.7%), pharyngoesophageal complications (1.9%), infections (12.3%), and neurological complications (7.5%). The survivors were 91.5% while deaths were 8.5%. Conclusion: The no-zone approach offers the ideal management for isolated PNIs in hemodynamically stable patients. It is advantageous over traditional approaches. Further studies are required to augment the evidence for its use as the gold standard management for such cases. Trial registration: the study was retrospectively registered at research registry with Research Registry UIN researchregistry5385 on February 26, 2020. Keywords: no zone approach, isolated penetrating neck injuries, hemodynamically stable patients, vascular injuries, laryngotracheal injury.

Download Full-text

A tailored protocol in management of penetrating neck injuries: experience at a level 1 trauma centre

International Surgery Journal ◽

10.18203/2349-2902.isj20210052 ◽

2021 ◽

Vol 8 (2) ◽

pp. 516

Author(s):

Ahmed M. Elshaer ◽

Hussein O. Elwan ◽

Doaa A. Mansour

Keyword(s):

Trauma Centre ◽

P Value ◽

Neck Injuries ◽

Conservative Group ◽

Missed Injuries ◽

Asymptomatic Patients ◽

Tailored Approach ◽

Zone Ii ◽

Sensitivity Specificity ◽

No Zone Approach

Background: The management of penetrating neck injuries (PNIs) evolved markedly over last year’s towards more conservative approaches. Recent improvements in imaging modalities as multi-detector CT-angiography (MDCT-A) produced a paradigmatic shift towards 'no-zone' approach. In this study, we adopted a tailored protocol to deal with such injuries with less dependency on zone classification.Methods: This prospective study included patients with PNIs from February 2012 to January 2014. Unstable patients and patients with hard signs in zone-II were managed by immediate exploration. Patients with hard signs in zones-I and III had MDCT-A to check feasibility of endovascular intervention. However, all patients with soft signs and asymptomatic patients underwent MDCT-A regardless the zone affected to determine the need for therapeutic intervention. Complementary investigations were added in some cases with equivocal MDCT-A results.Results: Our study included 85 patients. Majority were males (94%; n=80) with mean age 27±4. Stabs were the main causative injury (51%; n=43). 63 (74%) patients were stable; with majority (64%; n=40/63) were symptomatic (18 presented with hard signs and 22 presented with soft signs). 53 (62%) patients had MDCT-A with sensitivity, specificity of 77%, 97% respectively and significant p value <0.05. After applying this protocol, we avoided 37% (31/85) non-therapeutic neck exploration, with only 4 (7.4%) negative cases on exploration. We experienced no missed injuries in the conservative group, yet 2 (3.7%) missed nerve injuries were encountered in intervention group.Conclusions: Zones-classification is losing popularity nowadays and shouldn't be the cornerstone of the new management protocols in PNIs. This selective tailored approach can be effectively used in management of PNIs. It avoids missed injuries and unnecessary explorations significantly.

Download Full-text

Experiences of Penetrating Neck Injuries in a Single Institution

10.21203/rs.3.rs-87520/v1 ◽

2020 ◽

Author(s):

Dongsub Noh ◽

Jin Ho Choi

Keyword(s):

Vital Signs ◽

Computed Tomographic Angiography ◽

Neck Injury ◽

University Hospital ◽

Neck Injuries ◽

Computed Tomographic ◽

Penetrating Neck Injury ◽

Tomographic Angiography ◽

Mechanism Of Trauma ◽

Complications And Mortality

Abstract Background: The neck is a particularly critical region to sustain penetrating injuries, due to the close approximation of the trachea, esophagus, blood vessels, and the spinal cord. A penetrating neck injury has the potential for serious morbidity and mortality. The purpose of this study is to evaluate the assessment and management of penetrating neck injuries.Methods: In this retrospective study, penetrating neck injury patients who were admitted to Eulji University Hospital Trauma Center, between December 2015 and December 2017, were analyzed for epidemiology, mechanism of trauma, injured organ, complications, and mortality.Results: Thirty-two patients presented with a penetrating neck injury. All patients underwent computed tomographic angiography to evaluate their injuries once vital signs were stabilized.Among these patients, 27 required surgical treatment. The most commonly injured organ was the trachea. Overall mortality was five, and the main cause of death was bleeding. The mortality was associated with initial systolic blood pressure at the hospital, Glasgow coma scale, transfusion and the abbreviated injury scale of neck.Conclusion: Meticulous clinical examination as well as early volume resuscitation is essential for treating penetrating neck injury patients. Aggressive fluid therapy during transfer to the hospital will help the patient, even if the damage is severe.

Download Full-text

EP.TU.854Happy Patients and Updated Open Wound Management Protocols

British Journal of Surgery ◽

10.1093/bjs/znab311.108 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Harish Peri ◽

Rafique Umer Harvitkar

Keyword(s):

Chronic Wound ◽

Clinical Audit ◽

Wound Dressings ◽

Wound Management ◽

Open Wound ◽

Current Management ◽

Pdsa Cycle ◽

Management Protocol ◽

Open Injuries

Abstract Introduction Open injuries have a potential for serious bacterial wound infections and may lead to long term disabilities, chronic wound or bone infection, and even death. This QI study was undertaken to ring in changes to the current management protocol and align them as per WHO guidelines. Method Implementing changes through a Plan-Do-Study-Act (PDSA) cycle post an initial clinical audit among 38 patients of the organization. Re-audits were done to measure the outcome against the standard and establish a new protocol. Results Initial audit showed only a dismal 37% (n = 14) of patients being managed as per WHO protocol. Patient satisfaction percentage (as measured by a questionnaire) was also low with only 54% of patients satisfied with the treatment. Significant variations were noted post implementation of changes after the first PDSA cycle where >90% (n = 35) of patients reported that they noticed better wound healing, transition to optimal performance and were satisfied with treatment outcomes. Conclusions Timely wound dressings, appropriate antibiotic prophylaxis and increased patient’s awareness on wound hygiene through means of regular educational sessions and updated management protocols have led to healthier patients, lesser long term disabilities and happy patients.

Download Full-text

Chronic trans-scaphoid perilunate dislocation: Current management protocol

Journal of Clinical Orthopaedics and Trauma ◽

10.1016/j.jcot.2020.05.006 ◽

2020 ◽

Vol 11 (4) ◽

pp. 523-528

Author(s):

Bhavuk Garg ◽

Sahil Batra

Keyword(s):

Current Management ◽

Perilunate Dislocation ◽

Management Protocol

Download Full-text

Utility of Screening for Blunt Vascular Neck Injuries with Computed Tomographic Angiography

Journal of Trauma and Acute Care Surgery ◽

10.1097/01.ta.0000195651.60080.2c ◽

2006 ◽

Vol 60 (1) ◽

pp. 209-216 ◽

Cited By ~ 92

Author(s):

Nathan P Schneidereit ◽

Richard Simons ◽

Savvas Nicolaou ◽

Douglas Graeb ◽

D Ross Brown ◽

...

Keyword(s):

Computed Tomographic Angiography ◽

Neck Injuries ◽

Computed Tomographic ◽

Tomographic Angiography

Download Full-text

A Rare Presentation of Pellet Injury in the Neck

ISRN Surgery ◽

10.5402/2011/306126 ◽

2011 ◽

Vol 2011 ◽

pp. 1-3 ◽

Cited By ~ 5

Author(s):

Bulbul Gupta ◽

Achal Gulati ◽

Divya Gupta

Keyword(s):

Vascular Injury ◽

Potential Risk ◽

Emergency Treatment ◽

Foreign Bodies ◽

Diagnostic Workup ◽

Neck Exploration ◽

Neck Injuries ◽

Rare Presentation ◽

Early Diagnostic

Penetrating neck injuries are dangerous and deserve emergency treatment by virtue of the vital structures present underneath. There is a potential risk of unrecognized vascular injury and retained foreign bodies with their associated complications in these wounds. Therefore, an early diagnostic workup to localize the site of injury and an immediate neck exploration are important.

Download Full-text

Post-destructive eye surgery, associated depression at Sekuru Kaguvi Hospital Eye Unit, Zimbabwe: Pilot Study

African Vision and Eye Health ◽

10.4102/aveh.v72i2.48 ◽

2013 ◽

Vol 72 (2) ◽

Author(s):

M. M. Kawome ◽

R. Masanganise

Keyword(s):

Cross Sectional Study ◽

Current Management ◽

Cross Sectional ◽

Systematic Random Sampling ◽

Eye Surgery ◽

Management Protocol ◽

Before And After ◽

Patient Health ◽

Study Population ◽

Structured Questionnaire

Destructive eye surgery is associated with more complications than just loss of visual functions of the eye and aesthetics. Currently there is very little published literature on post-destructive eye surgery associated depression. Zimbabwe has been experiencing a surge in the rate of destructive eye surgery done at the National Tertiary Eye Unit. This situation could be churning out lots of unrecognized depressed clients into the community who require assistance in one form or another.Objectives: To determine the prevalence of post-destructive eye surgery associated depression among patients attending Sekuru Kaguvi Hospital Eye Unit and assess if the current management protocol of patients undergoing destructive eye surgery at the Eye Unit addresses the problem adequately.Methods: A cross-sectional study of 28 randomly selected patients who had destructive eye surgeries at Sekuru Kaguvi Hospital was conducted over five months from 1st March 2012 to end of July 2012. A structured questionnaire containing 15 questions on the following items: gender, age, diagnosis, surgical procedure done, expectations before and after surgery, adequacy of counseling given and involvement of family was used to collect data. Nine questions to assess depression were adapted from the Patient Health Questionnaire (PHQ-9).Setting: The study was conducted at SekuruKaguvi Hospital Eye Unit, Parirenyatwa Group of Hospitals in Harare.Results: Twenty-eight patients who underwent destructive eye surgery during the study period were selected using systematic random sampling. The gender ratio was 1:1 and the mean age was 38.7 years with a range from 24 to 65 years. Fifty percent of the patients in the study had orbital exenteration while the rest had enucleation (14%) and evisceration (36%). Twenty-eight percent of the study population had depression.Conclusion: Destructive eye surgery is frequently associated with depression and our current management protocol of patients undergoing destructive eye surgery does not address this problem.

Download Full-text