Keywords
treatment of neck injuries
trachea
intubation
reconstructive procedures
wound canal
How to Cite
Abstract
In press
Background. The number of patients with neck injuries in combat conditions is constantly increasing due to the features of personal protective equipment.
Aim. To study the diagnostic and surgical treatment features of a gunshot tracheal wound using primary reconstructive technologies.
Materials and Methods. A clinical case of a 43-year-old patient wounded in the left lateral surface of the neck was studied. The study was conducted using the clinical observation method. The clinical case is described for educational purposes and demonstrates a modern approach to the treatment of massive tracheal injuries. The article is intended for surgical trainees. Diagnostics included ultrasound examination, laboratory tests, multislice computed tomography of the head, neck, chest and abdominal cavity, and videoesophagogastroduodenoscopy. Surgical intervention was performed, including primary wound debridement, removal of a metal fragment, placement of a lower tracheostomy, resection of damaged semirings of the cervical trachea, tracheocricoid anastomosis, drainage of the paratracheal space, and chin-to-chest fixation. The study was conducted as part of the second author's dissertation research.
Research Ethics. The study complies with the principles of the World Medical Association Declaration of Helsinki (1964–2024). Informed consent was obtained from the patient for the treatment provided, participation in the scientific research, and publication of clinical materials and images.
Results. According to MSCT of the chest upon admission, damage to the first four semirings of the cervical trachea, a foreign body in the soft tissues of the neck, and tracheal intubation through the wound canal were detected. The surgical intervention lasted 1 hour and 45 minutes. The postoperative period was uneventful. The tracheostomy tube was removed on day 10, drains on day 11, and fixation sutures on day 14. The obtained results indicate the effectiveness of the chosen surgical strategy and the feasibility of performing primary reconstructive surgery for massive tracheal injuries.
Conclusions. Primary reconstructive operations are effective for gunshot tracheal wounds and ensure the restoration of its anatomical integrity and function. Treatment success depends on timely diagnosis, excision of non-viable tissue, and sufficient tracheal mobilization without anastomotic tension. At the prehospital stage, readiness for alternative intubation methods or tracheostomy is necessary. Important steps include myoplasty of the anastomosis area and chin-to-chest fixation.
Keywords: surgery, treatment of neck injuries, trachea, intubation, reconstructive procedures, wound canal.
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