Spectrum of Cervical Injuries and Results of Surgical Management in Cut Throat Cases
Keywords:
Cut throat, penetrating neck injuries, laryngo-tracheal framework, cervical tracheal injury, complete tracheal transection, delayed presentation.Abstract
OBJECTIVE: To evaluate the frequency, management and outcomes of cervical tracheal injuries in penetrating neck trauma at a high-volume trauma center.
METHODOLOGY: A prospective cross-sectional study on cut-throat cases was conducted at the Department of Thoracic Surgery, Jinnah Postgraduate Medical Centre, Karachi, from December 2022 to March 2024. Patients (>12 years) presenting with laryngo-tracheal framework or platysma breach were included and managed according to Advanced Trauma Life Support protocols, followed by surgical exploration and repair. Demographics, mechanism of injury, presentation time, operative details, and outcomes were recorded and analyzed using SPSS version 22.
RESULTS: The cohort comprised 30 patients (80% of whom were male), with a mean age of 34.6±10.8 years. Mechanisms of injury were homicidal (n=13; 43.3%), suicidal (n=11; 36.6%), and accidental (n=6; 20%). All patients sustained tracheal injury, with 50% complete transection and 50% anterior wall involvement, often with associated thyroid (n=15; 50%) and esophageal (n=13; 43.3%) trauma. The airway was secured via tracheostomy (n=17; 56.6%) or endotracheal intubation (n=13; 43.3%). Morbidity occurred in 53.3% (n=16) of cases, the most common being atelectasis (n=14; 46.6%) and wound infection (n=11; 36.6%). Respiratory distress post-weaning ventilatory support occurred in (n=6; 20%), and aspiration pneumonia in (n=5; 16.6%), mainly with combined trachea-esophageal injuries. Mortality was 10% (n=3), exclusively among patients presenting >2 hours post-injury with hypoxia and major associated injuries.
CONCLUSION: Penetrating cervical tracheal injuries require rapid airway stabilization and early surgical intervention to optimize outcomes. Delayed presentation, complete tracheal transection, and associated cervical injuries significantly increase morbidity and mortality.
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