COMPLICATIONS OF WOUNDS IN THE NECK. '.iX\) 



entering the blood stream, an accident which is favoured by the 

 negative blood pressure in this vessel, and by its liability to gape 

 in consequence of attachment to neighbouring tissues. The escape 

 of dark-coloured blood in a strong steady stream points to injury 

 of the jugular vein, and calls for its secure ligation, which must be 

 performed on both sides of the wound ; on the peripheral side to 

 stop bleeding, on the central side to prevent entrance of air into the 

 blood stream. 



Free bleeding in jets indicates injury of the carotid or of one 

 of the larger arteries, and necessitates ligation of the injured 

 vessel. The closure of small skin wounds in no way removes the 

 danger, because the blood accumulating under the skin and loose 

 connective tissue of the throat presses on the trachea, and may threaten 

 suffocation. There should, therefore, be no hesitation in ligaturing 

 the carotid. At the point of bleeding, a cut must be made parallel 

 with and a little above the jugular, dividing the skin and subscapulo- 

 hyoideus muscle. The loose connective tissue is pressed to one 

 side with the index finger, and the vessel, easily recognised by its 

 distinct pulsation, sought, drawn forward, separated from the vagus, 

 sympathetic and recurrent, and after being twice ligatured, 

 severed between the two threads. Section of the vessel is intended 

 to prevent tearing away at the point of ligation, which is favoured 

 by the natural tension of the carotid. 



It is necessary to remark that the blood may flow in a regular 

 stream, and not in jerks, even in injuries of the carotid. This is 

 the case where the blood does not find direct exit, but flows under 

 the skin or into the connective tissue spaces. A red colour and 

 powerful stream always suggest injury to the carotid. 



(3) The larger nerve trunks, like the vagus, sympathetic and 

 recurrent, may be injured. From nerve injuries roaring has repeatedly 

 been seen to result in the horse. Where injury to the nerve exists, 

 or is suspected, the strictest antiseptic precautions must be observed 

 to prevent extension of inflammatory processes, and to bring about 

 regular and early closure of the wound. When nerve rupture has 

 occurred the ends should be sutured. 



(4) Wounds in the neck may be complicated with perforation 

 of the trachea ; and though such a condition is seldom directly fatal, 

 it occasionally leads to death, from blood entering the trachea and 

 lungs and producing suffocation. The emphysema often seen about 

 the neck of sheep after injuries (dogbites) to the trachea is a serious 

 if not always a dangerous, complication. Tracheal injuries are 

 recognised by the bloodstained discharge from the nose, the frothy 



