Contents List of contributors ix Preface xi Acknowledgments xii Introduction – Kenneth L Mattox xiii Section – Operating Room General Conduct Trauma operating room Kenji Inaba and Lisa L Schlitzkus 12 Trachea and larynx 94 Elizabeth R Benjamin and Kenji Inaba Section – Resuscitative Procedures in the Emergency Room Cricothyrotomy Peep Talving and Rondi Gelbard Thoracostomy tube insertion 12 Demetrios Demetriades and Lisa L Schlitzkus Emergency room resuscitative thoracotomy Demetrios Demetriades and Scott Zakaluzny Insertion of intracranial pressure monitoring catheter 29 Howard Belzberg and Matthew D Tadlock Evacuation of acute epidural and subdural hematomas 35 Gabriel Zada and Kazuhide Matsushima 13 Cervical esophagus 101 Elizabeth R Benjamin and Kenji Inaba Section – Chest 14 General principles of chest trauma operations 107 Demetrios Demetriades and Rondi Gelbard 18 15 Cardiac injuries 115 Demetrios Demetriades and Scott Zakaluzny 16 Thoracic vessels 126 Demetrios Demetriades and Stephen Varga Section – Head 11 Vertebral artery injuries 88 Demetrios Demetriades and Nicholas Nash 17 Lung injuries 140 Demetrios Demetriades and Jennifer Smith 18 Thoracic esophagus 150 Daniel Oh and Jennifer Smith 19 Diaphragm injury 162 Lydia Lam and Matthew D Tadlock Section – Neck Neck operations for trauma: general principles Emilie Joos and Kenji Inaba Carotid artery and internal jugular vein injuries 53 Edward Kwon, Daniel J Grabo, and George Velmahos 20 General principles of abdominal operations for trauma 165 Heidi L Frankel and Lisa L Schlitzkus Subclavian vessels 69 Demetrios Demetriades and Jennifer Smith 21 Damage control surgery 172 Mark Kaplan and Demetrios Demetriades 10 Axillary vessels 83 Demetrios Demetriades and Emilie Joos 47 Section – Abdomen 22 Gastrointestinal tract 180 Kenji Inaba and Lisa L Schlitzkus vii Contents 23 Duodenum 189 Edward Kwon and Demetrios Demetriades 33 Upper extremity fasciotomies 288 Jennifer Smith and Mark W Bowyer 24 Liver injuries 198 Kenji Inaba and Kelly Vogt 34 Upper extremity amputations 294 Peep Talving and Scott Zakaluzny 25 Splenic injuries 209 Demetrios Demetriades and Matthew D Tadlock 26 Pancreas 219 Demetrios Demetriades, Emilie Joos, and George Velmahos 27 Urological trauma 228 Charles Best and Stephen Varga 28 Abdominal aorta and visceral branches Pedro G Teixeira and Vincent L Rowe 35 Femoral artery injuries 303 George Velmahos and Rondi Gelbard 36 Popliteal artery 307 Peep Talving and Nicholas Nash 240 37 Lower extremity amputations 314 Peep Talving, Stephen Varga, and Jackson Lee 29 Iliac injuries 257 Demetrios Demetriades and Kelly Vogt 38 Lower extremity fasciotomies 323 Peep Talving, Elizabeth R Benjamin, and Daniel J Grabo 30 Inferior vena cava 262 Lydia Lam and Matthew D Tadlock Section – Pelvis 31 Surgical control of pelvic fracture hemorrhage Peep Talving and Matthew D Tadlock Section – Lower Extremities 273 Section 10 – Orthopedic Damage Control 39 Orthopedic damage control 337 Eric Pagenkopf, Daniel J Grabo, and Peter Hammer Section – Upper Extremities 32 Brachial artery injury 281 Peep Talving and Elizabeth R Benjamin viii Index 345 Section Chapter Neck Neck operations for trauma: general principles Emilie Joos and Kenji Inaba Surface anatomy  For trauma purposes, the neck is divided into three distinct anatomical zones Although these zones not directly impact clinical decision making, they are important for documentation and communication purposes  Zone I: from the sternal notch to the cricoid cartilage  Zone II: from the cricoid to the angle of the mandible  Zone III: from the mandible to the base of the skull Zone III Zone III Zone II Zone II Zone I Zone I Fig 7.1 For trauma purposes, the neck is divided into three distinct anatomical zones: Zone I, from the sternal notch to the cricoid cartilage; Zone II, from the cricoid to the angle of the mandible; Zone III, from the mandible to the base of the skull Atlas of Surgical Techniques in Trauma, ed Demetrios Demetriades, Kenji Inaba, and George Velmahos Published by Cambridge University Press © Cambridge University Press 2015 47 Chapter Neck operations for trauma (c) (d) Fig 7.2(c),(d) Fig 7.2(a-d) Bleeding from a deep penetrating injury to the neck may be controlled by placement of a Foley catheter into the wound and inflation of the balloon with sterile water  Always place intravenous lines in the arm opposite the injury, especially in periclavicular injuries with suspected subclavian vein injury  In suspected major venous injury, place patient in the Trendelenburg position and occlude the wound with gauze, in order to reduce risk of air embolism (a) Suprasternal notch Positioning  The patient should be in the supine position  If the cervical spine has been cleared, a roll should be placed under the shoulders to provide extension of the neck  If a sternocleidomastoid incision is planned, the head is slightly extended with the placement of a shoulder roll and turned to the opposite side of the injury For a collar incision the head is kept in the midline position Mastoid Fig 7.3(a) Position of patient for a sternocleidomastoid incision: the head is slightly extended with the placement of a shoulder roll and turned to the opposite side of the injury 49 Section 4: Neck Vagus nerve Common carotid artery Fig 8.2 Carotid sheath contents The carotid sheath contains the common carotid and internal carotid arteries medially, the internal jugular vein laterally, and the vagus nerve posteriorly between the vessels LEFT FACE Internal jugular vein Internal jugular vein Fig 8.3 The facial vein is the anatomical landmark approximating the location of the carotid bifurcation deep to it The facial vein is ligated and divided in order to mobilize the internal jugular vein laterally and provide exposure to the underlying carotid bifurcation Facial vein LEFT FACE 54 Chapter 15 Cardiac injuries (a) (b) Fig 15.10(a),(b) (cont.) Fig 15.10(a),(b) A Foley balloon can be used to temporarily control the bleeding from a cardiac wound Exert gentle traction on the catheter to achieve tamponade of the wound Avoid excessive traction to prevent pulling the balloon through the defect and creating a larger wound  Skin staples may be used temporarily for cardiac wound closure in the emergency room, and are primarily effective for stab wounds This does not work well in patients who have sustained gunshot wounds associated with cardiac tissue loss The staples should be replaced by sutures in the operating room  Partial transection of a major coronary artery can be repaired with interrupted sutures under magnification, while the heart is beating If this is not technically possible, ligation is performed and the cardiac activity is observed Distal injuries are usually tolerated well If no arrhythmia develops, then nothing further is required If arrhythmia occurs, the suture is removed and gentle finger pressure is applied, while a cardiac team with cardiopulmonary bypass capabilities is mobilized  Cardiopulmonary bypass is largely unnecessary during the acute operation The surgical goal is to save the patient’s life Any non-life-threatening intracardiac defects should be repaired electively under optimal conditions at a later stage  Inspection and repair of injuries to the posterior cardiac wall can be difficult, as lifting of the heart often causes arrhythmia or cardiac arrest These injuries can be exposed and repaired by grasping the apex of the heart with a Duval clamp and applying mild traction and elevation Another option is to place a figure-of-eight 2–0 suture on a tapered needle through the apex of the heart for traction and elevation This option should be performed cautiously because the myocardium may tear during traction An alternative approach is to 121 ... Always place intravenous lines in the arm opposite the injury, especially in periclavicular injuries with suspected subclavian vein injury  In suspected major venous injury, place patient in the Trendelenburg... the cricoid to the angle of the mandible; Zone III, from the mandible to the base of the skull Atlas of Surgical Techniques in Trauma, ed Demetrios Demetriades, Kenji Inaba, and George Velmahos... for trauma: general principles Emilie Joos and Kenji Inaba Carotid artery and internal jugular vein injuries 53 Edward Kwon, Daniel J Grabo, and George Velmahos 20 General principles of abdominal