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Subcutaneous emphysema, particular in the neck, provides insight for

aerodigestive tract injuries.

CT can characterize soft tissue fluid accumulation versus diffuse

edema.

3. Magnetic Resonance Imaging and Ultrasonography

There is a limited role, if any, for magnetic resonance imaging or

ultrasonography in the management of acute soft tissue trauma.

C. Laboratory Assessment

1. Complete Blood Count

A complete blood count can help evaluate blood volume from traumatic

loss. However, acute measures may be deceivingly normal if third space

fluid volumes have not yet mobilized to the endovascular space.

2. Chemistries

Chemistries help denote overall fluid status and renal function,

particularly in cases where general anesthesia may be necessary.

Blood sugar may be reactively elevated in severe trauma, but dra-

matic elevations may also identify the closet diabetic patient. This

factor is important in wound healing and infection risk.

3. Toxicology

Toxicology should be used to identify elevated blood alcohol levels, the

presence of narcotic drug use, and even the use of prescription medica-

tions that may impair the patient’s sensorium and contribute to cardio-

vascular or neurologic side effects. Again, toxicology is important for

the overall patient assessment and in cases that require anesthesia.

III. Surgical Decision-Making Principles

A. Timing of Wound Repair

1. Primary Closure

Primary closure is ideal and should be accomplished within approxi-

mately 4–6 hours after wounding.

2. Delayed Primary Closure

Delayed primary closure is considered, with gross contamination

deemed highly prone for infection (even after extensive debridement

and copious irrigation).

Here the wound is debrided, irrigated, packed, or cleansed over 24–72

hours, followed by a detailed closure, usually in the operating theater.

Parenteral antibiotics are commonly employed with delayed closure.