Hirshberg A, Wall M J, Johnston R H, Burch J M, Mattox K L
Cora and Webb Mading Department of Surgery, Baylor College of Medicine, Houston, Texas 77030.
Am J Surg. 1994 Mar;167(3):309-12. doi: 10.1016/0002-9610(94)90206-2.
Gunshot injuries across the cervical midline are not addressed in existing trauma algorithms. A retrospective study of 41 patients with transcervical gunshot wounds was undertaken to delineate injury patterns and management principles. Thirty-four of the 41 patients (83%) sustained 52 injuries to major cervical structures. Vascular (22 injuries) and upper airway (13 injuries) structures were most commonly involved. This resulted in presentation with life-threatening problems in 16 patients (39%). The in-hospital mortality was 10%. In 30 of the 36 neck explorations (83%), the findings were positive for injuries to cervical structures. Sixteen bilateral explorations were performed; in each case, cervical injury was observed on at least one side of the neck. These results indicate that transcervical injuries are excellent markers of associated visceral injury. Therefore, a policy of mandatory neck exploration and a particularly "low threshold" for bilateral exploration are the key to managing these injuries.
