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Tue Mar 17 16:33:20 GMT 2009

Hmmm, obviously I was a little unclear with my description of the injury. Let me try again.

This was NOT a neck GSW. The bullet entered in the posterior midline at the T3 level, transected the spinal cord, in and out through the trachea and hit the sternum at about the sterno-manubrial junction. 

I am trying to get de-identified .jpgs of the CT and the esophagram to post but I believe we have ruled out esophageal injury because 1. her esophageal anatomy is somewhat unusual in that it does not have the usual left-right-left of midline sinusoidal curve. It remains left of midline throughout its course and underlies the trachea only to about c4. 2. we have a good Barium swallow (not gastrograffin) which does not demonstrate an injury. 3. No odyneophagia while she was awake and co-operative.

In order to explore the trachea we would have to perform either a high right thoracotomy or a sternotomy.

So, two questions:

1. Assuming she has isolated trachea injury do we have to fix a trachea with 2 .38 inch holes in it or can this be managed non-operatively?

2. Dr. Gill -- do you have any information on hyaluronic acid and it's use in tracheal injury? It hasn't crossed my radar screen. Anyone else with any experience with this?

Ok that was 3 questions, sorry.

Bill

William J. Bromberg, MD, FACS
Savannah Surgical Group
912 350-7412

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