RESUMO
El trauma penetrante de cuello es una emergencia que constituye un reto al cirujano desde la evaluación inicial hasta su manejo definitivo. Se presenta el caso de una paciente femenina de 24 años, con lesión penetrante transversal de cuello, con salida de aire por el sitio de la lesión junto a sangrado activo, requiriendo en el manejo inicial de vía aérea definitiva y control de hemorragia; ingreso quirúrgico de emergencia. Con hallazgos de: sección de membrana tiroidea a nivel del borde superior de cartílago tiroides, epiglotis y ambas venas yugulares anteriores. La conducta fue reparación por planos, desde lo profundo a la superficie. La experiencia adquirida en el manejo del presente caso permite resaltar que, seguir los lineamientos del soporte vital junto a la atención definitiva en un tiempo menor de 24 horas ante un trauma penetrante de cuello incrementa la probabilidad de éxito en el manejo y evolución.
Penetrating neck trauma is an emergency that challenges the surgeon from initial evaluation to definitive management. The case of a 24-year-old female patient with a transverse penetrating neck injury is presented, with air escaping through the injury site along with active bleeding, requiring a definitive airway and hemorrhage control in the initial management; with emergency surgical admission, with findings of: section of the thyrohyoid membrane at the level of the upper edge of the thyroid cartilage, epiglottis and both anterior jugular veins.The behavior was repair by planes, from the depths to the surface. The experience acquired in the management of this case allows us to highlight that following the life support guidelines together with definitive surgical trauma care in less than 24 hours in the event of penetrating neck trauma increases the probability of success in management and evolution.
O trauma cervical penetrante é uma emergência que constitui um desafio para o cirurgião desde a avaliação inicial até seu manejo definitivo. É apresentado o caso de uma paciente do sexo feminino, 24 anos, comlesão cervical penetrante transversal, com vazamento de ar pelo local da lesão. .lesão juntamente com sangramento ativo, exigindo manejo inicial de via aérea definitiva e controle da hemorragia; com internação cirúrgica de emergência, comachados de: secção da membrana tireoidia na ao nível da borda superior da cartilagemtireóidea, epiglote e ambas as veias jugulares anteriores. O comportamento foi reparado por aviões, desde as profundezas até à superfície. A experiência adquirida no manejo deste caso permite destacar que seguir as orientações de suporte à vida juntamente com o atendimento definitivo ao trauma cirúrgico em menos de 24 horas em caso de trauma cervical penetrante aumenta a probabilidade de sucesso no manejo e evolução.
Assuntos
Humanos , Feminino , Adulto , Adulto Jovem , Cartilagem Tireóidea/cirurgia , Cartilagem Tireóidea/lesões , Ferimentos Penetrantes/cirurgia , Lesões do Pescoço/cirurgia , Emergências , Tratamento de Emergência/métodosRESUMO
BACKGROUND: Burn sequelae involving the anterior neck and thorax produce a difficult challenge for reconstruction because contracture of anterior thoracic burns in addition to functional movement of the chest wall can result in downward displacement of the neck unit. The purpose of this study was to understand the influence of burn sequelae of the anterior thorax on anterior neck flap descent, function, and aesthetics. METHODS: Ten patients with burn sequelae of only the anterior neck (group 1) and 10 additional patients with burn sequelae of the anterior neck and thorax (group 2) were retrospectively identified. All 20 patients were treated with scar release and a single extended circumflex scapular free flap for neck resurfacing. Patients were followed for an average of 10 years, at which time flap descent from the sternal notch, deficit of neck extension, and subjective reports of discomfort were measured. RESULTS: Patients in group 1 experienced a median flap descent of 0 [interquartile range (IQR), 1.62 cm] and a median deficit of 0° (IQR, 5°) during neck extension. Patients in group 2 experienced a median flap descent of 8 cm (IQR, 1.75 cm) and a median deficit of 12.5° (IQR, 10°) during neck extension. Retrospective analysis of the 10 patients with burn sequelae of the anterior neck and thorax (group 2) demonstrated a significantly greater degree of flap descent and deficit of neck extension compared with the 10 patients with burn sequelae of only the anterior neck (group 1). Patients in group 1 also subjectively reported less discomfort at follow-up compared with patients in group 2. CONCLUSIONS: We conclude that patients with burn sequelae involving the anterior neck and thorax have a significantly greater degree of flap descent and neck extension compared with patients with burn sequelae involving only the anterior neck. Flaps of a larger surface area or use of multiple flaps for neck resurfacing may be considered to avoid significant flap descent associated with burn sequelae involving both the anterior neck and thorax.
Assuntos
Queimaduras/complicações , Cicatriz Hipertrófica/cirurgia , Contratura/cirurgia , Retalhos de Tecido Biológico/transplante , Procedimentos de Cirurgia Plástica/métodos , Cicatrização/fisiologia , Adulto , Queimaduras/diagnóstico , Queimaduras/cirurgia , Cicatriz Hipertrófica/etiologia , Estudos de Coortes , Contratura/etiologia , Feminino , Seguimentos , Retalhos de Tecido Biológico/irrigação sanguínea , Rejeição de Enxerto , Sobrevivência de Enxerto , Humanos , Escala de Gravidade do Ferimento , Masculino , Pescoço/fisiopatologia , Pescoço/cirurgia , Lesões do Pescoço/complicações , Lesões do Pescoço/diagnóstico , Lesões do Pescoço/cirurgia , Estudos Retrospectivos , Medição de Risco , Transplante de Pele/métodos , Tórax/fisiopatologia , Resultado do TratamentoRESUMO
BACKGROUND: The purpose of this study was to evaluate the role of a non-locking plate applied to the anteromedial surface of the proximal humerus on loads at the implant-bone interface of non-locking and locking lateral plate fixation of proximal humeral fractures with a medial gap. METHODS: Twenty synthetic humeri models were used. In fifteen, the proximal portion of the humerus was osteotomized to create a two-part surgical neck fracture, with a 10-mm medial gap and a 5-mm lateral gap; five models were controls. In the osteotomized humeri, five models were stabilized with a locking lateral plate (group L), five with a locking lateral plate and an anteromedial non-locking plate (group L+T), and five with a non-locking lateral plate and a non-locking anteromedial plate (group T+T). All humeri were tested under axial loading until catastrophic failure, which was characterized as complete closure of the medial gap. Stiffness was calculated using force vs. displacement curves. The data were analyzed via descriptive and inferential studies, at a 5% significance level. RESULTS: Statistically significant differences were seen among all the constructions. The combination of a lateral locking plate with an anteromedial non-locking plate (group L+T) was the stiffest construction, while the combination of a non-locking lateral plate with a non-locking anteromedial plate (group T+T) was the least stiff, even in comparison with a single locking lateral plate (p = 0.01). When the two groups which utilized a lateral locking plate (groups L+T and L) were compared, the group with additional anteromedial support demonstrated greater stiffness (p = 0.03), and stiffness values for the control group comprised of intact humeri models were even higher (p = 0.01). CONCLUSION: Combining a lateral locking plate with a non-locking anteromedial plate provides a stiffer construction for fixation of unstable two-part proximal humerus fractures with a medial gap. Mechanical benefits of medial support with a second non-locking antero-medial plate seems to be related with better construct stability in terms of strength and fatigue, potentially reducing the risk of varus collapse of the humerus head and fracture healing disturbances.
Assuntos
Placas Ósseas , Fixação Interna de Fraturas/métodos , Lesões do Pescoço/cirurgia , Fraturas do Ombro/cirurgia , Fenômenos Biomecânicos , Parafusos Ósseos , Estudos de Casos e Controles , Osso Cortical , Fixação Interna de Fraturas/classificação , HumanosRESUMO
RESUMEN Los traumatismos en cuello se pueden clasificar las lesiones en contusas y penetrantes, en el caso de las heridas penetrantes las ocasionadas por arma punzocortante son las más frecuentes. Las manifestaciones clínicas dependen del mecanismo del trauma, tamaño y nivel de la lesión. Paciente masculino de 26 años de edad con heridas por arma punzocortante en cuello y muñecas se ingresó a quirófano de urgencia, se realizó una exploración vascular de cuello encontrando una avulsión completa del ligamento cricotiroideo, se realizó la reparación del defecto con un colgajo de los músculos cricotiroideos, cursando una buena evolución es egresado al duodécimo día. El diagnóstico de las lesiones traqueales es desafiante y debe realizase rápidamente. Se debe instalar una vía aérea definitiva de manera eficaz y planear la reconstrucción quirúrgica. El seguimiento postoperatorio realizado de manera interdisciplinaria es esencial para el pronóstico(AU)
ABSTRACT Neck injuries can be classified as blunt or penetrating injuries. Penetrating injuries caused by a puncturing gun are the most frequent. The clinical manifestations depend on trauma mechanism, and on lesion size and degree. We present the case of a 26-year-old male patient with puncture injuries to the neck and wrists. After he was admitted to the emergency room, a vascular exploration of the neck was performed, finding a complete avulsion of the cricothyroid ligament. The defect was repaired with a flap of the cricothyroid muscles. The patient had a good evolution and was discharged on the twelfth day. The diagnosis of tracheal lesions is challenging and must be carried out quickly. A definitive airway should be installed efficiently, as well as the planning of the surgical reconstruction. The postoperative follow-up performed in an interdisciplinary way is essential for the prognosis(AU)
Assuntos
Humanos , Masculino , Adulto , Retalhos Cirúrgicos/transplante , Traqueia/lesões , Ferimentos Penetrantes/cirurgia , Lesões do Pescoço/cirurgia , Músculos Laríngeos/transplanteRESUMO
RESUMEN Se estima que al menos del 5 al 10 % de todas las lesiones traumáticas del organismo afectan el cuello. En el 30 % de los casos se afecta alguna estructura importante de esta zona del cuerpo humano. Las estructuras vasculares aparecen lesionadas en el 20 % mientras que las estructuras aerodigestivas en un 10%. Las lesiones de la zona I por diversas razones anatómicas y los órganos que incluye son de difícil manejo. Se presentan dos pacientes con lesiones vasculares de la zona I del cuello. Se realizó una revisión del tratamiento de las lesiones traumáticas del cuello con especial énfasis en las de la zona I. Se abordan diferentes tendencias actuales en el manejo de estos pacientes (AU).
ABSTRACT It is appraised that at least 5 to 10 % of all the organism trauma lesions involve the neck. In 30 % of the cases, any main structure of this zone is hurt. Vascular structures are damaged in 20 % while airway-digestive structures are injured in 10 %. The zone I lesions are difficult to handle because of several anatomic reasons and the organs they include. The cases of two patients with vascular lesions in the neck zone I are presented. A review of the treatment of neck trauma lesions was carried out, making special emphasis on the ones in zone I. Several current tendencies in these patients handling are dealt with (AU).
Assuntos
Humanos , Masculino , Adulto , Lesões do Pescoço/cirurgia , Lesões do Pescoço/diagnóstico , Lesões do Pescoço/história , Lesões do Pescoço/prevenção & controle , Lesões do Pescoço/terapia , Lesões do Pescoço/epidemiologia , Lesões do Sistema Vascular , Exame Físico , Ferimentos e Lesões/mortalidade , Técnicas de Laboratório Clínico , Técnicas e Procedimentos Diagnósticos , Testes Diagnósticos de RotinaRESUMO
INTRODUCTION: Neck burn sequelae remain a major challenge for the reconstructive surgeon. To achieve satisfactory functional and aesthetic results, the anterior neck aesthetic unit must be covered as a single unit. In cases where free flaps are required, harvesting a flap of sufficient size can cause major donor site morbidity. In 1994, we published our favorable 6-year experience of reconstructing neck burn sequelae with an extended circumflex scapular flap (ECSF). Since then, we have made several modifications to the technique, resulting in improved long-term functional and aesthetic results. Herein, we present our 30-year, 150-patient experience with the ECSF flap for the treatment of anterior neck burn sequelae. METHODS: We retrospectively reviewed the records of 150 consecutive patients who underwent ECSF procedure for neck resurfacing performed or supervised by the senior author from 1986 to 2015. All cases were assessed for function, aesthetics, satisfaction, and complications. RESULTS: A total of 160 ECSFs were used in 150 patients. Ninety-nine patients were available for updated follow-up [1-30 years (mean, 15.3)]. At the last follow-up, 92 patients regained full range of motion, and 90 patients had acceptable cervicomental angle (<110°). The mean patient satisfaction score was 4.8/5. Nine flaps (5.6%) failed completely and were successfully replaced. Twenty-two patients (15%) had distal necrosis of the flap. Fifteen of these 22 patients underwent complementary flaps to replace the necrotic area, and all 15 patients regained full range of motion. CONCLUSIONS: For neck burn sequelae, the ECSF provides safe and effective long-term functional and aesthetic results with minimal donor site morbidity.
Assuntos
Queimaduras/cirurgia , Lesões do Pescoço/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Retalhos Cirúrgicos , Adulto , Árvores de Decisões , Feminino , Humanos , Estudos Retrospectivos , Escápula , Fatores de Tempo , Adulto JovemRESUMO
Introducción: la exanguinación es una entidad clínica dramática que requiere rapidez de pensamiento y acción para obtener buenos resultados.Presentación del caso: se reporta el caso de un paciente de 13 años que sufrió accidente automovilístico y fue atendido en el Hospital Pediátrico Eliseo Noel Camaño , de la provincia de Matanzas, Cuba. El niño llegó con múltiples traumas en miembros superiores e inferiores, y una herida penetrante en el cuello que requirió tratamiento quirúrgico inmediato para controlar hemorragia. Se necesitó un acceso multidisciplinario de intensivistas, anestesiólogos, cirujanos pediátricos, neurocirujanos y cirujanos vasculares, porque la cuantía del sangrado y la localización de la lesión hicieron sospechar una afección traumática de la arteria vertebral. El niño sobrevivió a la lesión exanguinante, y actualmente se encuentra en proceso de recuperación.Conclusiones: la lesión penetrante del cuello puede provocar ruptura traumática de la arteria vertebral, entidad infrecuente que requiere alta sospecha diagnóstica para lograr éxito en su tratamiento. Consideramos vital la visión multidisciplinaria, en la que deben prevalecer maniobras seguras, rápidas y eficientes(AU)
Introduction: exsanguination is a dramatic clinical condition that requires quick analysis and action to achieve good results.Case report: this is a 13 years/old patient who suffered a car accident and was seen at Eliseo Noel Camano pediatric hospital in Matanzas province, Cuba. The teenager had many upper and lower limb traumas and a penetrating neck injury that required immediate surgery to control hemorrhage. It was necessary to involve intensive care experts, anesthesiologists, pediatric surgeons, neurosurgeons, and vascular surgeons because the amount of bleeding and the location of injury aroused the suspicion of traumatic damage of the vertebral artery. The teenager managed to survive from the exsanguinating injury and is currently in his recovery process.Conclusions: the penetrating neck injury may cause traumatic rupture of the vertebral artery, an uncommon condition that requires great diagnostic suspicion in order to succeed in treatment. It is vital to have a multidisciplinary vision in which safe, rapid and effective procedures should prevail(AU)
Assuntos
Humanos , Masculino , Adolescente , Hipovolemia/cirurgia , Lesões do Pescoço/cirurgia , Artéria Vertebral/lesõesRESUMO
Aim: The aim of this study is to report the surgical outcomes in a series of patients undergoing to exploratory cervicotomy by penetrating neck trauma (PNT) in emergency department of Barros Luco-Trudeau Hospital (BLTH), between 2003 and 2013, in terms of postoperative morbidity (POM). Matherial and methods: Retrospective case series of patient undergoing exploratory cervicotomy in emergency department of BLTH, between 2003 and 2013. The outcome variable was development of POM. Other variables were age, sex, etiology and kind of injury, hemodynamic status at admission, surgical time, distribution of injuries by anatomic areas, need for re operation and intra and post operative mortality. Descriptive statistics were used. Results: During the study period, 59 exploratory cervicotomies were performed to patients with PNT, with an average age of 32,5 years old. 89,8 percent of patients were male. The POM was 33,4 percent, being the most frequent the neurological ones. The most frequent etiology was the stab with 83 percent. 66 percent of patients were hemodynamically unstable at admission. Mean operative time was 107 minutes. The most injured area was the area II. Conclusion: The PNT is a little prevalent disease. The outcomes of our study are consistent with those reported in the literature.
Objetivo: El objetivo de este estudio es comunicar los resultados quirúrgicos observados en una serie de pacientes sometidos a cervicotomía exploradora por trauma cervical penetrante (TCP) en el Servicio de Urgencias del Hospital Barros Luco-Trudeau (HBLT), entre los años 2003 y 2013, en términos de morbilidad postoperatoria (MPO). Material y método: Serie de casos retrospectiva de pacientes sometidos a cervicotomía exploradora en el servicio de urgencia del HBLT, entre el año 2003 y 2013. La variable resultado fue desarrollo de MPO. Otras variables fueron: edad, sexo, etiología y tipo de lesión, estado hemodinámico al ingreso, tiempo quirúrgico, distribución de la lesión según zona anatómica, necesidad de re operación y mortalidad intra y post operatoria. Se utilizó estadística descriptiva. Resultados: En el período en estudio, se realizaron 59 cervicotomías a pacientes con TCP, con un promedio de edad de 32,5 años, de los cuales el 89,8 por ciento era de sexo masculino. La MPO fue de 33,4 por ciento, siendo las más frecuentes las de tipo neurológico. La etiología más recurrente fue el arma blanca con 83 por ciento. El 66 por ciento de los pacientes se encontraban hemodinámicamente inestables al momento del ingreso. El tiempo quirúrgico promedio fue de 107 min. La zona más lesionada fue la zona II. Conclusión: El TCP es una entidad poco prevalente. Los resultados obtenidos en nuestra serie son coincidentes con lo reportado en la literatura.
Assuntos
Humanos , Masculino , Adolescente , Adulto , Feminino , Adulto Jovem , Pessoa de Meia-Idade , Ferimentos Penetrantes/cirurgia , Ferimentos Penetrantes/etiologia , Lesões do Pescoço/cirurgia , Lesões do Pescoço/etiologia , Duração da Cirurgia , Complicações Pós-Operatórias , Estudos Retrospectivos , Ferimentos por Arma de Fogo , Ferimentos PerfurantesRESUMO
La extensión de un enfi sema facial sin neumotórax, hacia el cuello o el mediastino, secundario a un traumatismo maxilofacial, es de baja frecuencia. En la literatura se encuentran pocos casos referidos y su presencia obliga a descartar la ruptura de vísceras cérvico-tóraco-abdominales. De un total de 744 pacientes con traumatismo facial ingresados en el Sanatorio del Norte de San Miguel de Tucumán, desde octubre de 1996 a septiembre de 2001, 57 pacientes presentaron enfi sema facial, 4 asociados a fractura de mandíbula, 3 a traumatismos faciales cerrados y 50 a fracturas faciales del tercio medio y superior (maxilar superior, senos paranasales, malar, órbita, arco cigomático y frontal). De estos últimos, 3 que tenían fractura del seno maxilar, cursaron con enfi sema de cuello y uno de ellos además con enfi sema mediastinal. Se relata la evolución clínica, diagnósticos diferenciales, conducta terapéutica y teorías de la diseminación del aire hacia el mediastino. Se realiza, además, una revisión bibliográfi ca
The extension of the facial emphysema without pneumothorax, toward neck or the mediastinum area, secondary to a traumatism maxillofacial, it is low frequency. In the literature they are few referred cases and their presence forces to discard viscera rupture of the neck, thorax or abdominal region. About a total of 744 patients with facial traumatism entered in the Sanatorium del Norte, of San Miguel of Tucumán, from October of 1996 to September of 2001, 57 patients presented facial emphysema, 4 associated to jaw fracture, 3 at closed facial traumatisms and 50 to facial fractures of the upper third of facial region (maxillary superior, paranasal sinus, orbit, zigomatic bone, zigomatic arch and frontal bone). Three patients had fracture of maxillary sinus and neck emphysema, one of them also developed pneumomediastinum. The clinical evolution is related, diff erential diagnoses, therapeutic and theories of the dissemination of the air toward the mediastinum. Bibliographical revision is preformed in this presentation
Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Pneumotórax/terapia , Lesões do Pescoço/cirurgia , Traumatismos Maxilofaciais/cirurgia , Enfisema Mediastínico/fisiopatologiaRESUMO
Non-iatrogenic traumatic cervical esophageal perforations are usually hard to manage in the clinical setting, and often require a careful and individualized approach. The low incidence of this particular problem leads to a restricted clinical experience among most centers and justify the lack of a standardized surgical approach. Conservative treatment of esophageal perforation remains a controversial topic, although early and sporadic reports have registered the efficacy of non-operative care, especially following perforation in patients that do not sustain any other kind of injuries, and who are hemodynamically stable and non-septic. We report a case of a patient sustaining a single cervical gunshot wound compromising the cervical esophagus and who was treated exclusively with cervical drainage, enteral support and antibiotics.
Ferimentos traumáticos do esôfago não iatrogênicos são de difícil manejo clínico e requerem condutas individualizadas e cuidadosas. Frente à baixa incidência dessa afecção, a maioria dos centros não possui experiência suficiente para a definição de uma conduta padronizada para o manejo de tais lesões. O tratamento conservador da perfuração do esôfago permanece um tema controverso, embora relatos mais recentes tenham documentado sua eficácia, especialmente após a perfuração, em pacientes que não apresentam outras lesões associadas, instabilidade hemodinâmica ou sinais de sepse. É apresentado aqui o caso de um paciente com ferimento por projétil no esôfago cervical tratado exclusivamente com manejo conservador, tendo sido realizados drenagem da lesão, suporte nutricional por meio de sonda nasoenteral e antibioticoterapia, com evolução satisfatória.
Assuntos
Adulto , Humanos , Masculino , Perfuração Esofágica/cirurgia , Esôfago/lesões , Ferimentos por Arma de Fogo/cirurgia , Lesões do Pescoço/cirurgiaRESUMO
Non-iatrogenic traumatic cervical esophageal perforations are usually hard to manage in the clinical setting, and often require a careful and individualized approach. The low incidence of this particular problem leads to a restricted clinical experience among most centers and justify the lack of a standardized surgical approach. Conservative treatment of esophageal perforation remains a controversial topic, although early and sporadic reports have registered the efficacy of non-operative care, especially following perforation in patients that do not sustain any other kind of injuries, and who are hemodynamically stable and non-septic. We report a case of a patient sustaining a single cervical gunshot wound compromising the cervical esophagus and who was treated exclusively with cervical drainage, enteral support and antibiotics.
Assuntos
Perfuração Esofágica/cirurgia , Esôfago/lesões , Ferimentos por Arma de Fogo/cirurgia , Adulto , Humanos , Masculino , Lesões do Pescoço/cirurgiaAssuntos
Vidro , Lesões do Pescoço/etiologia , Jogos e Brinquedos/lesões , Ferimentos Penetrantes/complicações , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço/cirurgia , Estudos Retrospectivos , Índice de Gravidade de Doença , Adulto JovemRESUMO
Introducción: La gravedad, las implicancias neurológicas y el alto costo del tratamiento de la fractura cervical, hacen de esta lesión un tema de suma importancia. Esta injuria provoca graves limitaciones e invalidez a los afectados, en su mayoría en plena actividad laboral, impactando en lo médico, social y económico. Objetivos: Describir los pacientes tratados quirúrgicamente de fractura cervical traumática en el Hospital Regional Rancagua, por el equipo de Neurocirugía dentro de un periodo de 4 años. Materiales y Métodos: Se evaluó - 24 pacientes con antecedente de fractura cervical el mecanismo del trauma, el tiempo transcurrido desde el ingreso hospitalario hasta la cirugía, nivel y compromiso de la lesión medular, tipo de abordaje quirúrgico, complicaciones médicas, quirúrgicas y seguimiento post-operatorio, entre otros. Resultados: 5 mujeres y 19 hombres, edad promedio 39 años (rango de edad 14 a 75 años), principales mecanismos de trauma fueron los accidentes automovilísticos-atropello (58 por ciento). El nivel medular más frecuentemente lesionado fue C4-C5 (25 por ciento). En el 50 por ciento de los pacientes se clasificó de entrada como Frankel A, por lo que un 50 por ciento de todos los pacientes ingresaron tetrapléjicos, y de estos, un 33 por ciento egresó tetraparéticos. Del ingreso a cirugía hubo un tiempo de espera promedio 5 días. Dentro de las complicaciones médicas la causa respiratoria (46 por ciento) fue la más frecuente, necesitando 64 por ciento de estos pacientes ventilación mecánica. Se registró 1 infección de herida operatoria donde el abordaje fue posterior. El Índice de Barthel promedio de 14 pacientes fue de 49 puntos. De 6 pacientes con puntaje Cero, 85 por ciento de estos ingresaron como Frankel A y 50 por ciento egresaron tetrapléjicos. Los pacientes se rehabilitaron en promedio de 2.5 meses. Discusión: Logramos objetivar nuestra realidad. La técnica quirúrgica fue prácticamente uniforme entre los pacientes, sin complicaciones...
Introduction: Gravity, neurological implications and high costs of treating cervical fracture, makes of this injury an issue of most importance. This injury causes severe limitations and disability to those affected, mostly in full working activity, impacting on the medical, social and economic. Objectives: To describe patients surgically treated for traumatic cervical fracture at the Rancagua Regional Hospital, by the team of Neurosurgery Department, within a period of 4 years. Materials and Methods: We evaluated 24 patients with an history of cervical fracture mechanism of trauma, the time from hospital admission to surgery, and commitment level of spinal cord injury, type of surgery, medical and surgical complications and follow-up post -operation, among others. Results: 5 women and 19 men, average age 39 years (ranging age from 14 to 75 years), major trauma mechanisms were motor vehicle accidents (58 percent). The most frequently injured spinal level was C4-C5 (25 percent). 50 percent of patients were classified as Frankel A at the admission, so that 50 percent of all patients admitted were quadriplegics, and of these, 33 percent were discharged as tetraparétic. Admission to the surgery were an average of 5 days. Within cause respiratory medical complications (46 percent) was the most frequent, requiring 64 percent of these patients mechanical ventilation. There was only 1 wound infection where the approach was posterior. The average Barthel Index of 14 patients was 49 points. In 6 patients with zero score, 85 percent were admitted as Frankel A and 50 percent egressed as tetraplejic. Patients were rehabilitated an average of 2.5 months. Conclusions: We were able to objectify our reality. The surgical technique was nearly uniform among patients without severe postoperative surgical complications...
Assuntos
Humanos , Adolescente , Adulto , Adulto Jovem , Pessoa de Meia-Idade , Acidentes por Quedas , Acidentes , Acidentes de Trânsito , Agressão , Lesões do Pescoço/cirurgia , Lesões do Pescoço/complicações , Lesões do Pescoço/epidemiologia , Lesões do Pescoço/etiologia , Lesões do Pescoço/mortalidade , Água , Chile , Estudos RetrospectivosRESUMO
UNLABELLED: The neck is vulnerable to trauma because of vital structures and possible major injuries with high morbidity and mortality rates. AIM: To evaluate the outcome in patients with penetrating cervical wounds. METHODS: The medical registries of 39 patients were analyzed retrospectively from 2001 to 2009. Penetrating wounds were defined as injuries that penetrated beyond the platysma muscle. Age, gender, etiology, wound site, injured structures, treatment, and outcome were analyzed. Fisher's exact test was adopted to establish the link between these variables and the outcome (discharge or death). RESULTS: Of 39 patients, 33 (84.62%) were men with a mean age of 28 years. The main cause was firearm projectiles - 19 (48.72%) cases; the most frequently affected zone was zone II - 29 (74.36%). Thirteen (33.3%) cases of hemodynamic instability were observed, and the average hospital stay was 14 (1-99) days. The main indication for surgical intervention was the presence of profuse hemorrhage, in eight (20.5%) cases. The main structures affected were the cervical veins (20.5%). There were eight (20.51%) deaths. Younger patients had a better prognosis. CONCLUSION: The mortality rate was 20.51%. Patients below age 26 years had a better prognosis.
Assuntos
Lesões do Pescoço/etiologia , Ferimentos Penetrantes/complicações , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço/mortalidade , Lesões do Pescoço/cirurgia , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Ferimentos por Arma de Fogo/complicações , Ferimentos Penetrantes/mortalidade , Ferimentos Penetrantes/cirurgiaRESUMO
O pescoço é vulnerável a traumatismos devido à grande quantidade de estruturas vitais, podendo ocorrer lesões importantes e com alta morbimortalidade. OBJETIVO: Avaliar resultados em pacientes vítimas de ferimentos penetrantes cervicais. MÉTODOS: Foram analisados retrospectivamente prontuários de 39 pacientes entre 2001 e 2009. Ferimentos penetrantes foram definidos como lesões que penetravam além do músculo platisma. Foram analisados idade, gênero, etiologia, localização dos ferimentos, estruturas lesadas, tratamento e desfecho. Foi verificada a associação entre essas variáveis e o desfecho (alta ou óbito) por meio do teste exato de Fisher. RESULTADOS: Dos 39 pacientes analisados, 33 (84,62 por cento) eram homens, com média de 28 anos. A principal causa de ferimento cervical penetrante foi projétil de arma de fogo, com 19 (48,72 por cento) casos e a zona mais acometida foi a zona II, com 29 (74,36 por cento). Foram observados 13 (33,3 por cento) casos de instabilidade hemodinâmica e o tempo médio de internação dos pacientes foi de 14 (1-99) dias. A principal indicação da exploração cirúrgica foi a presença de hemorragia profusa em oito (20,5 por cento) dos casos. As principais estruturas acometidas foram veias cervicais (20,5 por cento). Ocorreram oito (20,51 por cento) óbitos. Pacientes jovens apresentaram melhor prognóstico. CONCLUSÃO: A mortalidade foi de 20,51 por cento. Pacientes com menos de 26 anos apresentaram melhor prognóstico.
The neck is vulnerable to trauma because of vital structures and possible major injuries with high morbidity and mortality rates. AIM: To evaluate the outcome in patients with penetrating cervical wounds. METHODS: The medical registries of 39 patients were analyzed retrospectively from 2001 to 2009. Penetrating wounds were defined as injuries that penetrated beyond the platysma muscle. Age, gender, etiology, wound site, injured structures, treatment, and outcome were analyzed. Fisher's exact test was adopted to establish the link between these variables and the outcome (discharge or death). RESULTS: Of 39 patients, 33 (84.62 percent) were men with a mean age of 28 years. The main cause was firearm projectiles - 19 (48.72 percent) cases; the most frequently affected zone was zone II - 29 (74.36 percent). Thirteen (33.3 percent) cases of hemodynamic instability were observed, and the average hospital stay was 14 (1-99) days. The main indication for surgical intervention was the presence of profuse hemorrhage, in eight (20.5 percent) cases. The main structures affected were the cervical veins (20.5 percent). There were eight (20.51 percent) deaths. Younger patients had a better prognosis. CONCLUSION: The mortality rate was 20.51 percent. Patients below age 26 years had a better prognosis.
Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço/etiologia , Ferimentos Penetrantes/complicações , Lesões do Pescoço/mortalidade , Lesões do Pescoço/cirurgia , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Ferimentos por Arma de Fogo/complicações , Ferimentos Penetrantes/mortalidade , Ferimentos Penetrantes/cirurgiaAssuntos
Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Vidro , Lesões do Pescoço/etiologia , Jogos e Brinquedos/lesões , Ferimentos Penetrantes/complicações , Lesões do Pescoço/cirurgia , Estudos Retrospectivos , Índice de Gravidade de DoençaRESUMO
Introduction: Penetrating neck trauma is a rare disease, but with high severity that affects the Emergency Room Services. Morbidity and mortality are due to injury of vascular structures and the aerodigestive tract. Conservative or surgical management depends on hemodynamic stability, the affected cervical zone and the presence of clinical signs of alert. Objective: To describe cervical penetrating trauma managed in the emergency unit of the Hospital Base Osorno, between January 2004 and April 2011 and review the literature. Material and Methods: We performed a retrospective review of all patients with penetrating cervical trauma seen at our center in this period. Results: Twelve patients were treated, nine were male. The average age was 29 years, ranging from 4 to 55 years. Zone II was the most affected with 9cases. Eight were stab injuries. The main surgical indications were active bleeding, subcutaneous emphysema and air exiting from the wound. The average length of hospital stay was 3,9 days. One patient died. Conclusions: In our center, penetrating neck trauma is a rare disease, which usually requires a surgical approach, forcing the emergency surgeon to be aware of warning signs to determine the need for surgical exploration or conservative management.
Assuntos
Humanos , Masculino , Adolescente , Adulto , Feminino , Criança , Pessoa de Meia-Idade , Lesões das Artérias Carótidas , Ferimentos Penetrantes/cirurgia , Traumatismos Torácicos/cirurgia , Lesões do Pescoço/cirurgia , Ferimentos e Lesões/cirurgiaRESUMO
Atualmente os traumas por arma de fogo estão cada vez mais comuns, principalmente na população com idadeprodutiva. Lesões cervicais por esse mecanismo são de grande importância por sua morbimortalidade. Suspeitardo diagnóstico e dar o suporte adequado é de extrema importância para salvar a vida do paciente. Nosso objetivo é descrever um caso de ferimento transfixante por PAF em região cervical, com fístula artériovenosa, que obteve um bom desfecho.
Nowadays traumas caused by firearms are more and more common, particularly among working age population. Cervical lesions caused by this mechanism are ofgreat importance for its morbimortality. Distrusting the diagnosis and giving the appropriate support is of the utmost importance to save the life of the patient. Our objective is to describe a case of transfixing wound by PAF in a cervical region, with arteriovenous fistula, which had a good outcome.