tailieunhanh - Essentials of General Surgery 5th Ed 2

(BQ) Part 2 book "Essentials of general surgery" presents the following contents: Trauma, burns, abdominal wall, including hernia, esophagus, stomach and duodenum, small intestine and appendix, colon, rectum and anus, pancreas, liver, breast, surgical endocrinology, spleen and lymph nodes, diseases of the vascular system, transplantation, surgical oncology: malignant diseases of the skin and soft tissue. | CHAPTER 9 I TRAUMA 179 can also occur with a straddle mechanism and have a common association with extraperitoneal bladder injury. PENETRATING NECK TRAUMA The neck is a highly complex anatomic region with critical vascular neurologic and aerodigestive structures concentrated within a very small area. Penetrating injuries to this region of the body are often the result of knife and gunshot wounds. Any wound that violates the platysma muscle carries a risk of injury to the great vessels trachea esophagus and spinal cord and therefore requires further assessment. For purposes of clinical evaluation and management of penetrating wounds the anterior neck from the midline to the anterior border of the sternocleidomastoid muscle is divided into three zones as illustrated in Figure 9-23. Zone I extends from the sternal notch to the inferior border of the cricoid cartilage. Zone II is the area from the cricoid cartilage to angle the mandible. Zone III includes the area of the distal neck which is from the angle of the mandible to the base of the skull. The management of penetrating injuries has largely evolved from military experience. During World War I nonoperative management was the standard approach but had an associated high mortality due to missed injury. During World War II the military s policy for management of these highly fatal wounds was mandatory surgical exploration which resulted in a significant reduction in mortality. This experience led to broad acceptance of mandatory exploration for all zone II penetrating wounds in civilian practice. During the next two decades numerous studies reported a high rate of negative or nonthera-peutic neck exploration with this policy. A number of authors began to advocate returning to a policy of selective management guided by hard signs and symptoms of injury to the vital structures to reduce the rate of nontherapeutic exploration. Initial evaluation of patients with penetrating neck wounds is determined by the physical .