Date of Procedure: 04/11/2015

Procedure: Left neck exploration, complex repair of left neck lacerations x 4, complex repair of bilateral upper
extremity stab wounds
Pre-procedure diagnosis: Left neck stab wounds measuring 3.0 cm, 3.5 cm, 2cm, and 2cm; right upper arm stab
wound measuring 7 cm, left upper arm stab wound measuring 6 cm.
Post-procedure diagnosis: same
Attending: Dr. Orlando Morejon
Assistants: Dr. Michael Keyes, PGY-2, Dr. Paul Perales, PGY-1
Anesthestic: GEA
Indications:
81 y/o F patient that was brought in by EMS team as a ground trauma alert after inflicting multiple stab wounds in
both arms and left side of the neck. The patient states that "she does not want to live". According to paramedics'
report, approximately 1L of blood was found on the scene initiating resuscitation. Vital signs were labile en route to
KRMC. Upon arrival to trauma bay, patient was hypotensive and noted to have pallor. Arterial bleeding was noted to
be present in the LUE laceration. At that point it was decided to take the patient to the OR to establish hemostasis
as well as to explore the neck wounds to evaluate for other injuries.
Procedure:
Patient was placed supine on in the operating room. A time-out was performed which confirmed the patients
identity, all team members, the locations and procedures to take place. The patient was given Ancef 1 gram IV prior
to the procedure. A foley catheter was placed prior to the start of procedure. The above wounds were prepped using
betadyne and draped using normal sterile technique. The R forearm laceration was measured to be 7 cm long
extending down to muscle with no active bleeding. The wound was copiously irrigated with normal saline. Then the
wound was closed using 3-0 vicryl sutures to approximate the fascial layers, with 3-0 nylon in a simple running
fashion to approximate the skin. The L forearm laceration was measured to be 6 cm extending down to muscle with
active bleeding from a small arterial perforator. The distal and proximal ends of the perforated were sutured ligated
using 3-0 vicryl. The wound was then copiously irrigated with normal saline. Then the wound was closed using 3-0
vicryl sutures to approximate the fascial layers then 3-0 nylon in a simple running fashion to approximate the skin.
Attention was then directed to the left neck. 4 lacerations, measuring superiorly to inferiorly 3 cm, 3.5 cm, 2 cm, 2
cm were noted. It was decided to perform a neck exploration to assess for further injury. A 10 scalpel was used to
make an incision along the anterior border of the left sternocleidomastoid muscle. A combination of sharp
dissection with Mayo scissors and Bovie electrocautery was used to explore the neck until a plane of healthy virgin
tissue was seen. It was noted that the left external jugular vein had a small branch that was bleeding. A 6-0 prolene
suture was using in a figure-of-eight fashion to obtain hemostasis. Next, the wounds were copiously irrigated using
normal saline. The muscle fascial layers were reapproximated using 3-0 vicryl and then the skin was closed using 30 nylon suture in a simple running fashion. The patient tolerated the procedure well and was sent to ICU intubated
for post-operative monitoring. There were no apparent complications.