Moore Retreat: Neck Injuries

Mandatory Zone 2 neck exploration:

- was the surgical dogma dating from Korean and Vietnam war

- This dogma is now changing with improvements in CT imaging and additional diagnostic testing to rule out injuries

- Mandatory exploration carries a 60% negative exploration rate

Selective Zone 2 neck exploration:

- now the approach in most centres

Zone 1 injuries:
- Use CT imaging to determine trajectory of injury
- trajectory helps you to guide further management

Quadroscopy not mandatory anymore
- With improvements in imaging, CT can guide further investigations if the tract is in proximity to other structures

Airway injuries
- Supraglottic injuries: ENT
- Below cricothyroid membrane: general surgery in Denver repairs primarily with 2-0 PDS interrupted sutures
- large injuries can be managed with a tracheostomy tube

Esophageal Injuries:
- rare
- Drain
- place a muscle interposition with SCM flap
- air in the mediastinum more commonly from a tracheal injury
- flexible esophagoscopy is first test: if you make a hole larger it need operative repair anyways
In OR: if unsure
- do an air leak test
- instill methylene blue or charcoal into esophagus and look for leak in neck or chest tube

Carotid Artery Injuries:
- Be wary of using shunts: any debris that flies past shunt can cause a devestating stroke
- Dr. Moore believes ALL carotid artery injuries should be repaired
- doesn't feel risk of hemorrhagic stroke is significant: short presentation times

Internal jugular veins:
- unilateral injury can be ligated

Vertebral artery injuries:
- Angio is primary treatment modality
- if vessel bleeds continuously in ER, can take to OR: make incision at base of neck, place balloon tamponade to get the patient to angio