Neck trauma repair

The neck has a skull, a lower thorax and a shoulder, and there is often a protective upper limb lift in the trauma, so the chance of a single trauma is small. However, the neck has large blood vessels, nerves, trachea, esophagus and other important organs. Once trauma, it may cause respiratory, digestive system or brain lesions, and even death due to major bleeding, asphyxia, and air embolism. Neck trauma can be divided into open and closed injuries. The former is caused by war wounds, work injuries or other accidents. Treatment of diseases: cervical vascular injury, acute neck and soft tissue injury Indication Open and closed trauma to the neck. Contraindications The patient is too old and should be filled with poor general condition. Preoperative preparation Prepare oxygen, aspirator, endotracheal intubation, and rescue medication. Surgical procedure According to the location of the injury and the degree of trauma, it should be described as follows: 1. Relieving suffocation and anti-shock treatment: patients with neck trauma are often accompanied by severe cases such as asphyxia and shock. Patients with symptoms of respiratory obstruction should be treated with tracheotomy at an early stage. At the same time, attention should be paid to blood pressure, heart rate, etc. Shock treatment. Including oxygen, blood transfusion, fluid replacement, use of cardiotonic, boosting drugs, hormones, etc. 2. Debridement: After flushing the wound with saline, disinfect the skin with sulphur, sulphur, and mercury. Because the neck soft tissue is rich in blood supply and the wound healing power is strong, it is not appropriate to remove too much tissue during debridement. Because the platysma muscle is closely related to the skin, the wound is often opened after trauma, and should be sutured carefully. The wound must be completely hemostasis, and some small bleeding points should be carefully ligated to avoid the formation of hematoma to compress the airway. Moreover, the anterior cervical vein and the cervical fascia are superficially adhered. After the injury, the vein wall is not easy to collapse, and it continues to drive. It is easy to invade and cause dangerous air embolism. Once the internal jugular vein is injured, the negative pressure during inhalation of the chest cavity is more likely to cause air embolism. 3. Treatment of laryngeal trauma: When the trauma is light, only the extramuscular muscle layer and soft tissue are involved, and the larynx cavity is not penetrated. In severe cases, thyroid cartilage, ring cartilage may be damaged, and even comminuted fracture and laryngeal mucosa avulsion may be achieved. The throat is connected. Main points of laryngeal trauma treatment: (1) Keep the laryngeal and pharyngeal mucosa as much as possible during surgery to avoid scarring of the throat. (2) Try to keep the structure such as vocal cords and false sound belts in their original position to maintain the basic functions of the throat. (3) Carefully dispose of the laryngeal cartilage. Any cartilage that has been detached from the perichondrium should be removed to avoid cartilage necrosis. Remove the broken cartilage as much as possible and suture the perichondial membrane closely with the surrounding tissue to ensure blood supply. (4) Patients with laryngeal trauma are often accompanied by irritating cough, and the throat has a large wound tension. The muscle layer, fascia, and skin should be firmly sutured layer by layer, and the rubber drainage strip should be placed. (5) For patients with severe injuries, destruction of laryngeal cartilage, and compression of the larynx, a tracheotomy should be performed immediately. The fragmented cartilage was carefully repositioned, and the cartilage was not discarded. After the reduction, the throat cavity mold made of plastic or silicone rubber was placed in the larynx cavity and fixed with stainless steel wire to prevent post-scarring stenosis. (6) The early symptoms of throat burns and burns may not be obvious, and must be observed closely for 4 to 6 hours to avoid delay. 4. Treatment of tracheal injury: often complicated by subcutaneous or mediastinal emphysema, timely diagnosis of tracheotomy after diagnosis, and then suture the trachea at the injury site. It is advisable to suture the cartilage ring and mucosa first, and then suture the anterior fascia 5. Treatment of cervical vascular injury: Large blood vessel injury in the neck can only be temporarily stopped by the occlusion method in the first aid (do not blindly use the hemostatic forceps), and then the upper limb of the healthy side is lifted over the head as a stent, and pressure dressing is performed. Do not remove the blockage easily when medical conditions are insufficient. Antibiotics can be used to control infection. It is advisable to perform vascular exploration after preparing for blood transfusion, anesthesia, surgery and other conditions. In addition to the external carotid vein and its branch hemorrhage can be ligated to stop bleeding, the other should be considered suture repair, and the ligation method should be considered when it is necessary. Experience has shown that the risk of ligating the common carotid artery is less than that of the internal carotid artery. The most severe condition of cervical vein injury is air embolism. When the air is inhaled into the large vein by negative pressure, a special "waterwheel murmur" can be heard when the air and blood are mixed in the right atrium, right ventricle and pulmonary artery. Because the air passes through a small circulation, it causes the right atrium and the right ventricle to expand extremely, the large veins are congested, and the left ventricle is emptied, and the large circulation pressure drops, causing extremely serious consequences. When rescued such patients, the patient should immediately lower his head, inhale oxygen, and compress the vein as soon as possible, or puncture the right ventricle to draw in the inhaled air. complication Concurrent laryngeal stenosis or esophageal stricture, until the condition is stable, consider repair.