PRESENTATION: 13 year old FS Terrier mix presented for treatment of injuries sustained in a dog fight.
PHYSICAL EXAMINATION: Subcutaneous emphysema was present in the cervical region and a cutaneous laceration was visible in the ventral midline cervical region. Respiration was stable.
DIAGNOSIS: Cervical radiographs documented subcutaneous emphysema. Thoracic radiographs revealed no pneumothorax or pneumomediastinum.
TREATMENT: The patient was anesthetized for exploration of the wound and for repair of the suspected tracheal trauma. During wound exploratory, a laceration of the cervical trachea was identified ventrolaterally on the left. Primary closure of the laceration was performed with simple interrupted 3-0 PDS sutures. The wound was debrided, lavaged and primarily closed. Baytril antibiotic therapy was initiated for 14 days.
OUTCOME: Subcutaneous emphysema resolved postoperatively and there was no occurrence of coughing or dyspnea. Wound healing progressed without complication.
DISCUSSION: Traumatic wounds in the cervical region can include tracheal and/or esophageal injury. Subcutaneous emphysema provides a clue that the trachea is not intact. Anesthesia induction and recovery are concerns with respiratory tract trauma patients. Tracheal intubation must be performed with care in order to bypass the potentially traumatized area. Some patients may require placement of a temporary tracheostomy tube.
Primary closure of the tracheal laceration was possible in this case. In cases of severe trauma, a resection and anastomosis may be indicated. Immature cats and dogs can tolerate resection of 20-25% of the trachea (7-10 rings) and adults can tolerate 25-50% (10-20 rings) without dehiscence of stenosis.
Traumatic crushing wounds can develop ischemic, non-viable tissue 3-5 days after the trauma and therefore should be monitored for wound drainage, swelling and dehiscence for that entire period.
