TRANSCERVICAL GUNSHOT INJURIES

Gunshot injuries across the cervical midline are not addressed in exis ting trauma algorithms. A retrospective study of 41 patients with tran scervical gunshot wounds was undertaken to delineate injury patterns a nd management principles. Thirty-four of the 41 patients (83%) sustain ed 52 injuries to major cervical structures. Vascular (22 injuries) an d upper airway (13 injuries) structures were most commonly involved. T his resulted in presentation with life-threatening problems in 16 pati ents (39%). The in-hospital mortality was 10%. In 30 of the 36 neck ex plorations (83%), the findings were positive for injuries to cervical structures. Sixteen bilateral explorations were performed; in each cas e, cervical injury was observed on at least one side of the neck. Thes e results indicate that transcervical injuries are excellent markers o f associated visceral injury. Therefore, a policy of mandatory neck ex ploration and a particularly ''low threshold'' for bilateral explorati on are the key to managing these injuries.