Abstract
Penetrating wounds of the neck are often life-threatening. The victims are exposed to vascular and laryngotracheal lesions. The purpose of this work is to report the various aspects of the management of penetrating wounds in our context and to make the medico-legal assessment of incapacity in the criminal sense or total incapacity for work. This is a retrospective study (2002-2014) on thirty-nine (39) cases of penetrating neck wounds, received at the ENT departments of the Aristide Le Dantec and Fann University Hospital Centers. Patients were predominantly male, representing 94% of cases with an average age of 27 years. Seventy (70%) of the accidents occurred in the region of Dakar. In 42% of cases, the circumstance of occurrence was a fight or an assault. The weapon used in most cases by the aggressor was a cutter or a knife. The average waiting time was 37 hours with extremes of 02 and 216 hours. Surgically, all patients had been examined under general anesthesia. In terms of lesions, 37 cases had profound cervical muscle injuries, i.e. 94%. There were 17 vascular lesions (43%). The medico-legal distribution of patients showed that among them, 10% had a total incapacity to work exceeding 21 days. The determination of total incapacity for work is an important medical procedure that requires capability and experience. The doctor must not fall into the trap of the confusion between the TIW on the criminal level and the TIW on the civil level. He must limit medically and should not make judgments.
Highlights
IntroductionPenetrating neck wounds are deemed difficult to assess because they concern a complex anatomical region, where several vital structures are concentrated in a small space [1]
The purpose of this work is to report the various aspects of the management of penetrating wounds in our context and to make the medico-legal assessment of incapacity in the criminal sense or total incapacity for work
The doctor must not fall into the trap of the confusion between the total incapacity for work (TIW) on the criminal level and the TIW on the civil level
Summary
Penetrating neck wounds are deemed difficult to assess because they concern a complex anatomical region, where several vital structures are concentrated in a small space [1]. The risk of vascular, upper air, neurological and/or pharyngo-oesophageal injury is real. It is difficult to estimate the frequency of these wounds because the majority of the victims die at the scene of the accident or during their evacuation. In Europe, the incidence is 1.3 per 100,000 inhabitants per year [2]. The frequency is much higher in the series that relate to the experience of the North American (48%) and South Africans (40 %) teams [3]. Penetrating traumas are uncommon in France they represent 10 up to 15% of trauma. White knives are the main agents involved, 65% of penetrating injuries. They are more important in the United States with a predominance of firearms [4]
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