Drago Prgomet

External laryngotracheal trauma

Differences in acute external injuries of the larynx and cervical trachea between peacetime and war trauma were studied. Twenty-six patients with peacetime injuries and 39 patients with war injuries were retrospectively analyzed. The incidence of peacetime laryngotracheal injuries was 0.91% of the total number of patients hospitalized for head and neck injuries. In the groups of wounded in action (WIA) and killed in action (KIA) with head and neck war injuries, the incidence of laryngotracheal injuries was 4.8 and 6.2%, respectively. According to the type of the wound, blunt injuries were most common among peacetime and penetrating wounds among war injuries. There was no difference between peacetime and war injuries according to the wound localization. War wounds were more severe, caused more extensive local tissue and organ defects, were associated with a greater number of lesions to the neck and other body regions and more often required reconstructive surgical procedures than peacetime injuries. The mortality of war laryngotracheal injuries was two times greater than that of peacetime lesions (9 vs. 3.8%).

Management of war-related neck injuries during the war in Croatia, 1991-1992.

From 1 September 1991 to 31 December 1992, a total of 7,043 wounded patients were treated in the War Hospital in Slavonski Brod. Seven hundred and twenty eight patients with head and neck injuries were treated in the Department of Otorhinolaryngology and Cervicofacial Surgery. Of this number, 187 had neck injuries. Ninety-two (49.2%) of them were treated in outpatient facilities and 95 (50.8%) as inpatients. Immediate exploration was done in 84 patients with penetrating neck injuries. Vital structures were involved in 49 patients: major blood vessels (40 cases), larynx (17 cases), pharynx (8 cases), trachea (5 cases), thyroid gland (3 cases) and esophagus (2 cases). Definitive treatment was given to all of these injuries. Primary wound closure was performed upon exploration in 74 patients who were treated within the first 6 h after trauma. Secondary wound closure was performed in 10 patients with neck exploration performed more than 6 h after injury, and in those with extensive defects of tissue requiring the use of larger local flaps or free flaps. The mortality among patients with neck injuries was 2.1 %.

Neurologic recovery after penetrating craniocerebral war injury.

From June 1, 1991, until December 31, 1992, 116 patients with penetrating craniocerebral war injuries inflicted at the east Slavonian front were treated at the Osijek University Hospital. There were 26 (22.4%) gunshot wounds and 90 (77.6%) wounds inflicted by explosive devices and projectiles. Four years after the injury, a study of the survivors’ condition was carried out. No difference was recorded in the survival rate between the patients with gunshot wounds compared with explosive wounds. Rehabilitation produced good results in the survivors, in the prevention of both acute and chronic complications and permanent damage. Older age, lower Glasgow Coma Scale, and level of consciousness were found to be prognostic indicators of outcome.