Junctional zones

Junctional zones

The key junctional zones are: ). /uni25CF between the neck and the thorax; /uni25CF between the thorax and the upper limbs; /uni25CF between the thorax and the abdomen; /uni25CF between the abdominopelvic structures and the groin. These zones represent surgical challenges in terms of both diagnosis of the area of injury and the required surgical approach. Such factors have to be balanced against the physi - ). ological stability of the pa tient. Root of the neck Most injuries a ff ecting the base of the neck may also a ff ect the upper mediastinum and thoracic inlet. Choice of access is determined by the need for surgical control of the vascular structures contained within. The mediastinum The mediastinum, with its major vessels and the heart, is also an extremely high-risk area for penetrating wounds. Any wound in this region should immediately raise the suspicion of a major vascular or an associated cardiac injury , even in the absence of initial gross physical signs. Diaphragm The thorax and abdomen are separated by the diaphragm, which is mainly responsible for breathing, allowing movement space. Any penetrating injury below the nipples on the chest may therefore have penetrated the diaphragm and entered the abdomen. Injuries in this junctional zone, therefore, should be investigated as if both cavities had been penetrated ( Figure 29.2 ). In blunt trauma, rupture of the diaphragm can result in migration of abdominal viscera into the chest, with left-sided hemidiaphragm rupture being more common. Pelvic structures The pelvis contains a large plexus of vessels, both venous and arterial. Should injury occur, control of haemorrhage can prove to be exceptionally di ffi cult and may require control of both arterial inflow and venous outflow . Angioembolisation can be a very useful adjunct to treatment, especially with deep pelvic injuries. Summary box 29.1 Junctional zones /uni25CF /uni25CF /uni25CF /uni25CF

Between neck and the thorax Between thorax and upper limbs Between thorax and the abdomen Between the abdominopelvic structures and the groin

Junctional zones

The key junctional zones are: ). /uni25CF between the neck and the thorax; /uni25CF between the thorax and the upper limbs; /uni25CF between the thorax and the abdomen; /uni25CF between the abdominopelvic structures and the groin. These zones represent surgical challenges in terms of both diagnosis of the area of injury and the required surgical approach. Such factors have to be balanced against the physi - ). ological stability of the pa tient. Root of the neck Most injuries a ff ecting the base of the neck may also a ff ect the upper mediastinum and thoracic inlet. Choice of access is determined by the need for surgical control of the vascular structures contained within. The mediastinum The mediastinum, with its major vessels and the heart, is also an extremely high-risk area for penetrating wounds. Any wound in this region should immediately raise the suspicion of a major vascular or an associated cardiac injury , even in the absence of initial gross physical signs. Diaphragm The thorax and abdomen are separated by the diaphragm, which is mainly responsible for breathing, allowing movement space. Any penetrating injury below the nipples on the chest may therefore have penetrated the diaphragm and entered the abdomen. Injuries in this junctional zone, therefore, should be investigated as if both cavities had been penetrated ( Figure 29.2 ). In blunt trauma, rupture of the diaphragm can result in migration of abdominal viscera into the chest, with left-sided hemidiaphragm rupture being more common. Pelvic structures The pelvis contains a large plexus of vessels, both venous and arterial. Should injury occur, control of haemorrhage can prove to be exceptionally di ffi cult and may require control of both arterial inflow and venous outflow . Angioembolisation can be a very useful adjunct to treatment, especially with deep pelvic injuries. Summary box 29.1 Junctional zones /uni25CF /uni25CF /uni25CF /uni25CF

Between neck and the thorax Between thorax and upper limbs Between thorax and the abdomen Between the abdominopelvic structures and the groin

Junctional zones

The key junctional zones are: ). /uni25CF between the neck and the thorax; /uni25CF between the thorax and the upper limbs; /uni25CF between the thorax and the abdomen; /uni25CF between the abdominopelvic structures and the groin. These zones represent surgical challenges in terms of both diagnosis of the area of injury and the required surgical approach. Such factors have to be balanced against the physi - ). ological stability of the pa tient. Root of the neck Most injuries a ff ecting the base of the neck may also a ff ect the upper mediastinum and thoracic inlet. Choice of access is determined by the need for surgical control of the vascular structures contained within. The mediastinum The mediastinum, with its major vessels and the heart, is also an extremely high-risk area for penetrating wounds. Any wound in this region should immediately raise the suspicion of a major vascular or an associated cardiac injury , even in the absence of initial gross physical signs. Diaphragm The thorax and abdomen are separated by the diaphragm, which is mainly responsible for breathing, allowing movement space. Any penetrating injury below the nipples on the chest may therefore have penetrated the diaphragm and entered the abdomen. Injuries in this junctional zone, therefore, should be investigated as if both cavities had been penetrated ( Figure 29.2 ). In blunt trauma, rupture of the diaphragm can result in migration of abdominal viscera into the chest, with left-sided hemidiaphragm rupture being more common. Pelvic structures The pelvis contains a large plexus of vessels, both venous and arterial. Should injury occur, control of haemorrhage can prove to be exceptionally di ffi cult and may require control of both arterial inflow and venous outflow . Angioembolisation can be a very useful adjunct to treatment, especially with deep pelvic injuries. Summary box 29.1 Junctional zones /uni25CF /uni25CF /uni25CF /uni25CF

Between neck and the thorax Between thorax and upper limbs Between thorax and the abdomen Between the abdominopelvic structures and the groin