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Background
- Defined by platysma violation
- Multiple structures are injured in 30%
- Stab wound can enter in one zone and damage another
- Surgery required in 15-20%
- Missed esophageal injury is leading cause of delayed death
Zones
- Zone 1: Clavicles to inf aspect of cricoid cartilage
- Highest mortality (usually due to exsanguination)
- Zone 2: Inf cricoid cartilage to angle of mandible
- Zone 3: Angle of mandible to base of skull
- Anatomical Structures at Risk:
- Blood vessels
- Carotid and vertebral arteries
- Brachiocephalic and subclavian vessels
- Jugular vein
- Lung apices
- Spinal cord
- Thoracic duct
- Brachial plexus
- Phrenic and vagus nerves
- Esophagus
- Dysphagia, hematemesis, blood in saliva
- Trachea
- CN 9-12
Management
- Airway
- Consider intubation in:
- Stridor
- Hemoptysis
- Subq emphysema
- Expanding hematoma
- Stridor
- Breathing
- Minimize BVM (positive pressure > air into soft tissue plains)
- Circulation
- Place IV on contralateral side of injury
- Imaging
- CT and CTA
- Useful for evaluating esophageal injury
- Angiography
- Useful if embolization or stent placement are anticipated
