Penetrating traumatic injury to the trachea inflicted with a knife

Among cervical traumas, tracheal injuries can be particularly life-threatening because of the risk of airway disruption and require immediate diagnosis and proper management Delays in diagnosis can cause a worsening of subcutaneous emphysema and dyspnea during the acute stage, resulting in cicatricial airway stenosis during later stages. However, the absence of specific symptoms and/or physical signs often makes a prompt diagnosis difficult. In this paper, we report three cases of penetrating traumatic injuries to the trachea and provide a review of the literature concerning traumatic tracheal injuries. All three patients in our case series experienced a penetrating cervical trauma consisting of stab wounds inflicted with a knife, including self-mutilation in one patient and attacks by others in two patients. All three patients underwent emergency surgery during which the injured tracheas were successfully repaired; the recoveries of all three patients were uneventful. Since definitive diagnosis by direct palpation of the wound was possible in only one patient, indirect clinical findings seem to be important for the diagnosis of tracheal injury. Subcutaneous emphysema appeared in all three patients, as it has previously been reported to develop frequently and nonspecifically. Air leakage was found in two patients, suggesting a relatively high specificity of this sign for airway injuries. Computed tomography implied tracheal injuries in two patients, but we could not determine the exact anatomical site and extent of the injuries. Although the injuries were located on the thoracic trachea in the two patients harmed by others, these lacerations were successfully closed using a transcervical approach through the primary cervical skin wounds. Based on our experiences and those reported previously, patients with penetrating cervical injuries who were harmed by others and/or whose skin wounds were located in the vicinity of the suprasternal notch should be suspected of having penetrating injuries to the thoracic trachea. Even if a physical examination is combined with diagnostic imaging, a definitive diagnosis of penetrating tracheal injury and the assessment of its exact location and extent can still be difficult. Therefore, in cases where a penetrating tracheal injury is suspected and if the patient's general condition permits, we recommend surgical exploration by exposing the trachea with sufficient counter-traction, followed by primary closure with appropriate sutures.