Cuts like a knife

Monday, February 11, 2008

Joe Theismann’s leg fracture, Napoleon McCallum’s knee dislocation and now Richard Zednik’s severed carotid artery. The Florida Panther hockey player was hurt when a teammate’s skate flew up in a fall and cut his neck. The blood injury has become the latest “must see” injury.

There are few exposed parts on a hockey player’s body and the neck and throat seem an unlikely target for a skate, but the sharp blade that cuts up the ice can do major damage. While we think of the neck injuries as limited to the spine and spinal cord, the soft tissues in front have significant life threatening potentials. While there is a protective muscle covering for the arteries and nerves, the trachea and some major veins lay just underneath the surface of the skin potentially exposed to injury.

For doctors assessing injury, the neck is divided into three zones. Zone 1 runs from the clavicle or collar bone to the cricoid cartilage (about the level of the adam’s apple, give or take a half inch). It contains the esophagus, trachea, thyroid gland and the jugular vein and carotid artery. Zone 2 runs from the cricoid to the angle of the jaw and includes the carotid arteries, the jugular veins, some of the nerves that serve the face, the voice box. Zone 3 runs from the jaw angle to the base of the skull and contains the carotids and jugulars again and more nerves.

For Mr. Zednik, there was no choice. With massive bleeding, the laceration must have penetrated the muscle layers and cut a major blood vessel. He needed emergency surgery to explore the depth of the cut, control the bleeding and repair whatever damage was found. While it is the most visible and spectacular injury with all the blood, other subtle injuries in the neck can be devastating.

Carotid artery lacerations can cause people to bleed to death and have strokes. Even after repair, there is a risk in the short term post op, that the blood vessel could clot or go into spasm and deprive part of the brain of blood supply and cause a stroke.

Damage to the esophagus can cause saliva and digestive juices to leak into tissues not able to tolerate the bacteria routinely found in saliva and the enzymes that are tough enough to digest food. Inflammation and infection can spread from the neck, through tissue planes into the chest and mediastinum, the space that surrounds the heart.

Injury to the cranial nerves, the short nerves from the base of the brain that control everything from facial movements to the ability to swallow and move our tongues to speak, can also affect the gag reflex. No gag and the chance to aspirate food, water and spit leads to recurrent pneumonia.

Cutting open the trachea speaks for itself. We take the ability to breathe very seriously.
Hopefully, the news for Mr. Zednik remains positive. It went as well as could be expected. Exploring his neck in the operating room; looking for potential injuries other than carotid artery; repairing what was found; recuperating in the ICU.

Sadly, there will be those who will want to watch the accident again and again, and television producers who will continue to broadcast it in the name of entertainment and news. Too bad they don’t show the operation too. Surgery isn’t pretty but at least the patient isn’t suffering like Joe, Napoleon and Richard.

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