Head and neck hemorrhage: Technical tools and tricks

Abstract

Background: The purpose of the present work is to provide a fresh, simple, and accessible document for all surgeons who treat traumatic hemorrhage from the head and neck.

Methods: This article arose from the work of a consortium of experienced trauma surgeons who collaborated to produce a first-of-its-kind surgical course for multifocal hemorrhage control. The "Bloody Simple Hemorrhage control masterclass course" has been offered at national and international venues since 2019 and has been both well received by participants and well regarded in academic trauma surgical circles. This paper-and the series of articles which accompany it-was meant to be a literature companion to or extension of the Bloody Simple course, a way to distill and digest the hemorrhage control strategies espoused therein but in the form of a journal article.

Results: The result of this work is a succinct and experience-based set of principles for conquering life-threatening, traumatic bleeding from a variety of sources in the head and neck.

Conclusion: This article translates experience and evidence into a simple and digestible format that will provide a sound approach for any surgeon facing traumatic hemorrhage from the head and neck.

Fig 1

Airway management algorithm for head and neck hemorrhage.

Fig 2

Anterior SCM incision + median sternotomy for exposure of hemorrhage at the base of neck/thoracic inlet junction.

Fig 3

Allis clamp control followed by complete dissection and repair of large caliber jugular venous injury from penetrating trauma.

Fig 4

Combined antegrade approach via ipsilateral carotid artery and retrograde approach via contralateral carotid artery and circle of Willis for embolization of skull base carotid injury with retained knife blade in situ.

Fig 5

Ligation of the external carotid artery as adjunct for severe midface hemorrhage.

Fig 6

Raney clips applied clinically to an exsanguinating scalp wound prior to definitive repair.