A Multidisciplinary Approach to Penetrating Neck Trauma in a Patient with Self-Inflicted Gunshot Injuries to Zones 1-3 of the Neck

Abstract

Penetrating neck trauma comprises 5%-10% of all traumatic injuries in adults and carries up to a 10% mortality rate for those affected. Management of penetrating neck trauma can be challenging and often requires a multidisciplinary approach. A case of penetrating neck trauma via self-inflicted gunshot wound to zones 1-3 of the neck in an intoxicated, suicidal 60-year-old man is presented. Immediately after stabilization by the trauma surgery team, surgical reconstruction using a pectoralis major pedicled myocutaneous flap was completed by the plastic and reconstructive surgery team. The patient’s hospital course was complicated by injury to the left phrenic nerve, oropharyngeal swallowing dysfunction, and left diaphragmatic dysfunction. The trauma team initiated prompt multidisciplinary responses to each of these complications as they arose by involving the plastic and reconstructive surgery, otolaryngology, gastroenterology, and speech language pathology teams. Early involvement of the physical medicine and rehabilitation, psychiatry, dietary, and pharmacy teams allowed for early optimization and monitoring of the patient’s mobility, psychological, and nutritional statuses. The timely initiation of multidisciplinary care in this patient’s case allowed for the patient to not only to survive a potentially fatal penetrating neck trauma, but to be discharged to a rehabilitation facility with an independent level of function. Given the complications due to severe penetrating neck trauma of zones 1-3 in this case, it is essential for early involvement of the appropriate subspecialty teams in order to achieve the best possible outcome for the patient.