Trauma cervical 2016
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Transcript of Trauma cervical 2016
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TRAUMA CERVICAL
H.Z.G.A. Dr. A. OñativiaResidencia de Cirugia General 2016
Migliavacca, MagdalenaLezana, Pedro
Thomas, M. Sofia
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ANATOMÍA QUIRÚRGICA
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ANATOMÍA QUIRÚRGICA
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ANATOMÍA TOPOGRÁFICA DEL CUELLO• TRIÁNGULO CERVICAL ANTERIOR
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ANATOMÍA QUIRÚRGICA
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ANATOMIA QUIRURGICA
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ANATOMIA QUIRURGICA
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ANATOMÍA QUIRÚRGICA
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FASCIAS DEL CUELLO
• Fascia Superficial
• Fascia Profunda:• Capa de Revestimiento• Capa Media o Pretraqueal• Capa Prevertebral
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FASCIA SUPERFICIAL
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FASCIA PROFUNDA
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FASCIA PROFUNDA
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COMPARTIMIENTO VISCERAL
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COMPARTIMIENTO VISCERAL
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ANATOMÍA QUIRÚRGICA
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ANATOMÍA QUIRÚRGICA
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ANATOMÍA QUIRÚRGICA
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ZONAS ANATÓMICAS DEL CUELLO
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ZONAS ANATÓMICAS DEL CUELLO
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ZONAS ANATÓMICAS DEL CUELLO
• ZONA I
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ZONAS ANATÓMICAS DEL CUELLO
• ZONA II
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ZONAS ANATÓMICAS DEL CUELLO
• ZONA III
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TRAUMA CERVICAL
• Epidemiología• Corresponde al 5 % de todos los traumas• 30% de los casos tienen lesiones asociadas• 11% de mortalidad• Hasta 55% de morbilidad• Trauma Vascular es la principal causa de Morbilidad y Mortalidad• 50% de las muertes son debido a trauma vascular y trauma del cordón
espinal
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TRAUMA CERVICAL
• Clasificación• TRAUMA CERVICAL PENETRANTE
• 95% de los casos
• TRAUMA CERVICAL CERRADO• 5% de los casos
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TRAUMA CERVICAL PENETRANTE
• 95 % de los Traumas Cervicales• Perspectiva Histórica:
• Primera Guerra Mundial: Tratamiento Expectante o Quirúrgico diferido (Mortalidad 36%) • Segunda Guerra Mundial: Exploración Quirúrgica es la regla ( Mortalidad 9%)• Actualidad: Manejo Selectivo ( Estudios Diagnósticos)
• Mecanismo del Trauma:• Arma Blanca vs Arma de Fuego
• Examen Físico: Sensibilidad 69%
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TRAUMA CERVICAL CERRADO
• 5% de los Traumas Cervicales• Mayor morbimortalidad que los traumas penetrantes• Cinemática del trauma:
• Accidentes de tránsito• Accidentes deportivos• Estrangulación o Ahorcamiento
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MANIFESTACIONES CLINICAS DE LAS LESIONES CERVICALES
LESIÓN CLÍNICA
Esófago-Faringe Enfisema Subcutáneo, Disfagia, Odinofagia, Hematemesis
Vascular Hematoma, Hemorragia, shock, ausencia de pulso, soplo, trastornos neurológicos y/o periféricos
Laringe-Tráquea Dificultad respiratoria, Estridor, Enfisema Subcutáneo, Ronquera, Disfonía, Hemoptisis.
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METODOS DIAGNÓSTICOS
• Radiografía Simple de Columna Cervical• Tomografía Axial Computarizada• Esofagograma• Esofagoscopia Rígida vs Flexible• Broncoscopia y Nasolaringeofibroscopia• Arteriografía• Eco Doppler color
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RADIOGRAFÍAS SIMPLES DE COLUMNA CERVICAL
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TOMOGRAFÍA
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MÉTODOS DIAGNÓSTICOS
Ventajas Desventajas
Sensibilidad 99%-100% Difícil evaluación de las porciones vasculares distales en zona I y III
No Invasivo Requiere Personal Entrenado
Económico No Terapéutico
No se obtiene Mapa Arterial
Eco Doppler
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ESOFAGOGRAMA
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BRONCOSCOPIA
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MANEJO DEL TRAUMA CERVICAL
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ATLS
• A-B-C-D-E
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• Establecer si la herida atraviesa el músculo platisma:• Zona I y III Estudios
complementarios (determina lesiones e indicación cirugía).
• Zona II Estudios complementarios v/sExploración quirúrgica (Si atraviesa platisma y lesión de estructura cervical).
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TRATAMIENTO DEL TRAUMA CERVIAL
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TRATAMIENTO DEL TRAUMA CERVICAL
• INDICACIONES ABSOLUTAS DE CERVICOTOMIA EXPLORADORA:• Inestabilidad Hemodinámica• Signos duros de lesión vascular• Burbujeo a través de la herida• Enfisema Subcutáneo• Déficit Neurológico (Trauma Penetrante)• Pérdida importante de tejidos Blandos• HAF en zona II
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Lesiones FaringoesofagicasConducta
• Incidencia: 9%• Pacientes asintomáticos: 35%• Mortalidad ‹ 12 horas: 9%• Mortalidad › 12 horas: 40 %• Conducta terapéutica varía según el tiempo de evolución:
• Reparación Primaria• Reparación Diferida
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Lesiones LaringotraquealesConducta
• Incidencia 16%• Mortalidad 35%• Conducta:
• Cirugías complejas con alto porcentajes de complicaciones
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Trauma Cervical Vascular Penetrante
• Incidencia:• Lesión Arterial: 13%• Lesión Venosa: 18%
• Mortalidad: 45%• Pacientes Asintomáticos: 45%• Conducta:
• Pacientes Inestables• Pacientes Estables
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Trauma Cervical Vascular Penetrante
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Trauma Cervical Vascular Cerrado
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Gracias!