Head and Neck Cancer Research

Primary tracheal reconstruction in cut-throat injury of a 4 years old child

Cut throat injuries in children are rare, but they constitute a significant management challenge. Such injuries are rarely reported in the literature. Evaluation and treatment of such injuries is a tough task. Cervical tracheal injuries are relatively uncommon and are frequently associated with esophageal, vascular or spinal injuries. We hereby report a case of cut throat injury with incomplete transection of trachea and its management in a four years old male child. History of homicidal attack by slashing his throat with sickle by his father at 3.00am on 26/1/2014. Family history: Father is a known psychiatric patient on irregular treatment. Child was received at GH Madurai by 5.25 am on the same day immobilized with neck and chest splint. Neck: A horizontal contused lacerated wound of 10cm*2 cm in the ant part of the neck just above the suprasternal notch, extending between two sternocliedomastoid muscles (Zone 1). Immediate resucitation started. Emergency wound exploration and primary closure of the trachea along with tracheostomy was planne under General anesthesia. Tetanus prophylaxis given. Transected trachea was sutured extramucosaly with interrupted 3-0 vicryl. The child was discharged home on post op day8.
Conclusion: Every case should be assessed based on the injury. Leading cause of death—hemorrhage from vascular structure. Worst complications: Laryngeal stenosis, pharyngeal stenosis, pharyngocutaneous fistula pharyngeal, hypo pharyngeal, laryngeal, tracheal mucosal lacerations should ideally be repaired early (within 24 hours). Primary airway repair without tracheostomy is possible, when the injury is repairable to near anatomy.

Author(s):

S A Panchappa and R K Swamirao

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