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Mon Aug 7 14:42:04 BST 2006

Navin

Suggest you observe for the moment - if he gets better without surgery these wounds often heal without sequelae. If the chest drains keep bubbling and there appears to be a bronco-pleural fistula, then go in and do something about it.

I would not operate at this stage1

Tim
Dr T C Hardcastle
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
ATLS  instructor and DSTC Cape Town Course Director
Intern program Coordinator: Surgery
Program Manager: Emergency Medicine (SU)
Clinical Head (Director): Diana Princess of Wales Trauma Unit
Department of Surgery Room 4064
Tygerberg Hospital / University of Stellenbosch
PO Box 19063
Tygerberg 7505
Western Cape
South Africa
e-mail: tch at sun.ac.za
Cell: +27824681615
Office: +27219389281 or 4911 pager 0302

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of navin goyal
Sent: Monday, August 07, 2006 2:55 PM
To: trauma-list at trauma.org
Subject: Traumatic Neck Wound

30 yr. old male attende my trauma ward . He had trauma as a large glass slab fell over his neck and chest . He had a wound in the neck just above the clavicle which was bubbling and bleeding . There were fractures in the ribd with bilateral decreased air entry on both side . There was collection of Blood in the mouth . Patient was immediately intubated . Bilateral Chest tubes were put and by the time the wound was explored it had stopped bubbling , bleeding was located to vessel in the muscle which was ligated and the wound closed .

  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??

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Traumatic Neck Wound