The Management of Penetrating Neck Injury With Retained Knife: 15-Year Experience From a Major Trauma Center in South Africa

Background This study reviews our cumulative experience with the management of patients presenting with a retained knife following a penetrating neck injury (PNI). Methods A retrospective cohort study was conducted at a major trauma center in South Africa over a 15-year period from July 2006 to December 2020. All patients who presented with a retained knife in the neck following a stab wound (SW) were included. Results Twenty-two cases were included: 20 males (91%), mean age: 29 years. 77% (17/22) were retained knives and 23% (5/22) were retained blades. Eighteen (82%) were in the anterior neck, and the remaining 4 cases were in the posterior neck. Plain radiography was performed in 95% (21/22) of cases, and computed tomography (CT) was performed in 91% (20/22). Ninety-five percent (21/22) had the knife or blade extracted in the operating room (OR). Formal neck exploration (FNE) was undertaken in 45% (10/22) of cases, and the remaining 55% (12/22) underwent simple extraction (SE) only. Formal neck exploration was more commonly performed for anterior neck retained knives than the posterior neck, although not statistically significant [56% (10/18) vs 0% (0/18), P = .096]. There were no significant differences in the need for intensive care admission, length of hospital stay, morbidities, or mortalities between anterior and posterior neck retained knives. Discussion Uncontrolled extraction of a retained knife in the neck outside of the operating room may be dangerous. Retained knives in the anterior neck commonly required formal neck exploration but not for posterior neck retained knives.

Transection of the Common Carotid and Vertebral Arteries Following a Penetrating Neck Injury

A case of a 30-year-old man who was admitted following a penetrating neck injury is presented. A clinical examination and operative findings identified semi-comatose mentality, neck muscle laceration, and transection of the left common carotid and vertebral arteries and the internal jugular vein. During the operation, the carotid arteries were repaired by interposition grafting, and the internal jugular vein was ligated. The vertebral artery was managed by interventional embolization. Although the patient had some neurological deficit, he was discharged on postoperative Day 52. This surgical case prompted a discussion regarding neurological outcomes, and surgical and endovascular treatment following vascular neck injury.

GUNSHOT WOUND TO THE NECK WITH THROMBOSIS OF THE COMMON CAROTID ARTERY IN THE DELAYED PERIOD. (ANALYSIS OF CLINICAL OBSERVATION)

A case of non-penetrating neck injury with contusion and dissection of the common carotid artery with transition to the internal carotid artery is presented in a clinical observation. The clinical picture of the development of brain failure after thrombosis of the common and internal carotid arteries and regression of brain symptoms after reconstructive surgery is presented. A mathematical model of the lesion mechanism is analyzed separately. It is concluded that in case of a nonpenetrating wound of the neck with a traumatic weapon, the revision of the underlying tissues should be mandatory.

A survived case of penetrating neck injury with intrathoracic organ damage

Background Thoracic surgeons rarely encounter stab wounds with injury to the intrathoracic organs. However, such sudden and urgent situations could arise; therefore, experiences in managing such cases are invaluable. Case presentation An 84-year-old woman with depression who had a stab injury in the neck caused by a broad-bladed kitchen knife was brought to our facility by ambulance. She was stable in the emergency room; however, a computed tomography scan revealed that the blade had penetrated the right thoracic cavity. A right hemopneumothorax was seen. Considering the possibility of injury to the major vessels, a median sternotomy was performed. During the dissection around the blade, the patient started bleeding profusely, which required repair of an injury to the right internal jugular vein. The blade tip had penetrated the dorsal right upper lung lobe; however, it did not reach the hilum, and the knife was carefully removed. The damaged area of the lung was removed by wedge resection. Conclusion Patients with deep stab wounds from knives are often hemodynamically stable because the blade acts as tamponade and prevents hemorrhage. Therefore, a surgical approach that allows for good visualization should be considered for the extraction of the blade.

Delayed cervical abcess on penetrating neck injury by arrow : a case report

Introduction. Les plaies pénétrantes du cou par flèche, quoique rares maintenant, peuvent être rencontrées dans certaines zones rurales de pays en développement, où l’accès aux soins hospitaliers demeure difficile. Observation. Nous rapportons le cas d’un patient congolais de 40 ans qui a consulté pour suppuration cervicale profonde, six mois après un traumatisme du cou par une flèche artisanale. L’exploration chirurgicale, après traitement antibiotique, a permis d’extraire le corps étranger vulnérant. L’évolution était favorable. Conclusion. Les plaies pénétrantes du cou par flèche artisanale nécessitent une prise en charge hospitalière précoce et adéquate par une équipe chirurgicale expérimentée afin d’éviter des suites compliquées voire désastreuses.