Resident Manual of Trauma to the Face, Head and Neck

y y Subcutaneous emphysema, particular in the neck, provides insight for aerodigestive tract injuries. y y 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 y y Chemistries help denote overall fluid status and renal function, particularly in cases where general anesthesia may be necessary. y y 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). y y Here the wound is debrided, irrigated, packed, or cleansed over 24–72 hours, followed by a detailed closure, usually in the operating theater. y y Parenteral antibiotics are commonly employed with delayed closure.

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