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Mon Aug 7 14:41:00 BST 2006

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

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