COMPLICATIONS OF WOUNDS IN THE NECK. 
139 
secretions, or of the blood discharge from the wound, as well as by 
emphysema in the neighbourhood of the wound. Bloody discharge 
from the nose, coughing, rattling in the throat, and dyspnoea point to the 
entrance of a large quantity of blood into the trachea. Where these 
symptoms occur, the bleeding vessels must be immediately tied and 
patients with injuries to the trachea, or in its neighbourhood, should not 
be left unattended. Extravasations in the neck sometimes lead to com- 
pression of the trachea and death from suffocation, and, where this 
threatens, tracheotomy becomes necessary. It is also called for where 
much blood has entered the lungs. A tampon canula is inserted, or the 
trachea plugged above the canula to prevent the blood passing down¬ 
wards. In such cases the tracheal tube must be fixed with especial care 
to prevent the tampons falling into the trachea. For this purpose, and 
in order to be able to remove the tampon more easily, it is well to 
encircle it with a piece of tape, which can be fastened round the neck. 
For further information, refer to the article on tracheotomy. 
(5) Injuries to the oesophagus are not so frequent. They usually occur 
in the lower third, on the left side of the throat. (Esophageal mischief 
is shown by the presence of chewed food or saliva in the wound. 
Though such wounds are not dangerous to life, they require a long time 
to heal. 
(6) Wounds lower down on the neck, usually produced by the carriage 
pole, or by running against obstacles, may extend 8 to 12 inches 
deep between the shoulder blade and thorax, and cause extensive destruc¬ 
tion of the muscular tissues of the shoulder and breast. I hey aie still 
more serious when they extend to the first ribs, or the space between them. 
Complicated fractures of the ribs are often produced in this manner. 
The wound, if confined to the muscular tissue, requires no particular 
attention, although fatal results occasionally ensue from extensive 
burrowing of pus, or from septicaemia. The extent of such injuries is 
sometimes difficult to ascertain at first, and foi a few 7 days diagnosis 
should be guarded. Where one or other of the ribs is injured, 
purulent pleuritis and death can seldom be averted. Early and con¬ 
tinuous irrigation should be adopted, and the wound in the skin and 
muscles laid open to allow free exit of discharge. This is even moie 
requisite where the injury extends to the muscular tissue of the breast, 
and under the shoulder. With free opening and the use of drainage- 
tubes such wounds, how T ever, usually heal satisfactorily. Injuiies 
involving the sternum are dangerous, because this bone is liable to 
become necrotic, producing so-called sternal fistula, which seldom oi 
never heals. To prevent such complications the wound must be caie- 
fully cleansed, continuously irrigated, or frequently rinsed out, and 
drainage-tubes or setons used. 
